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I Permit No. ---- -- . APPLICATION FOR SANITATION PERMIT a (complete in Duplicate) Date Issued .----- a`} \`� /1``' 4 � i hereby made to the San Joaquin Local Health Distri 549r a permit +o construct and install the work herein described, Application s . Y This application is'made �n compliance with County Ordinance v ------•-------------- .,� JOB ADDRESS AND LOCATION..--- ------ ---------------- ---- ,� Phone-.,/f Y W Owner-s Name_ -� '' Y , -----•-------•-------- � ,. f Address>_.� `�' ? C----------------- one -- Ph Contractor's Name------------------ '= - Trailer Court ❑ Motel ❑ Other ❑ J Apartment H66se ❑ Commercial ❑ off---------------------- Installation will serve: Residence Ap , ---- Number of living um}s; __�-__ Number of bedrooms .__�_-- Number of baths __-�--- Lot size ___,.1`-J�,� - ------ -- Private ❑ Depth to Water Table Water Water Supply: Public system Community system ❑ Clay Loam ❑" Clay ❑ Adob " Hardpan ❑ i Gravel Sandy Loam ❑ Y Character of soil to a depth of 3 feet: Sand ❑ ❑ Previous Application Made: Yes ❑ NoNew Construction: Yes.k No El TYPE OF INSTALLATION AND SPECIFICATIONS: No se tic tank or cesspool permitted if public sewer is available within 200 feet.) �. DistanceFfram foundition___� Material___ __-._ '- Septic Tank: Distance from nearest We ---- ��• L� u,d de th__-_5 - -. I----:-Capacity-.__ - - No. of compartments------ - ---- $ize_ q i? i Disposal Field: Distance from nearest well_._. ------Distance from foundation___ U • --_Width ofttrenchest lot lin --------- Distance ___ Number of lines--------------- l ----------Length of each line_----- ------ r� ❑ Type of filter material------------- L-__---- -----------of falter material____._------------•--Total length-------------- - 1 Distance to nearest lot line --- --- Seepa a Pit,. Distanc to nearest ''- f Distance fA fourSdat'son_-__.__. epth_"` � -----� ------- See txe: Di ! j' r'` i �' er of • its __/ --- ------Liramq tor r . f Cesspool: Distance from nearest well-----------------Distance from foundation_.__- ------ Linin material----- -- --gals. ---De Depth ------------------------------ ------ ------Liquid Capacity--- --------------•------ ❑ Size: Diameter_________________ __ --- -------- pI 4Distance from nearest Well-------------------------- Distance from nearest building Privy: - --------- - -------- Distance ---- - Distance to nearest lot line__.___-------------------------------- Remo el' g and/or repairing (describe}:_ '� - --------------------------- ------------ - ------------•------------------------------------------ - -- •-- ----- ordinance --- 1 hereby certify that I have pendaredulatsons off the San JoaquinhLocalwork HealltheDistric}n accordance with San Joaquin County ordinances, State laws, and rules 9 .. ----------- (Signed) - - (Owner and/ ) �'/ Contractor S� ned = = ' { .g �----•------�-------- �._- f --------------------------------------------- ---------------------- - -- ------- -----(Title) 1��=�------- _ _:��-�--------- � -------------------- BY� ._ ,_.__�° (Plot plan, showing size offot, location of system in relation to wells, buildings, etc., can be pla ed on reverse side: FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_____-___---------------- ------- DATE--------------------- - --------- -------•--- DATE_--------------------•----------•--- ---- REVIEWEDBY--------------------------------------------- --------------------------------- DATE--------------------------• ------------------------------- ----------------- BUILDINGPERMIT'ISSUED------------------------ ------------------------------•----------- ---------•---------•------- Alterations and/or recommendations:-------------------- -------------------- ------- --- ---------------------------•---------------- -- •------------------------ k- •--------•---- ----------------- -----..----- FINAL INSPECTION BY:_.__-- -- Date_._.. ---- = - ------ SAN JOAQ_ ,UIN LOCAL HEALTH DISTRICT 132 Sycamore Street 814 North "C" Street 130 South American Street 300 West Oak Street Trac California Stockton, California Lalli, California Manteca, California y' cc—a—aM 10-52 Revised W-2100 _....