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R = APPLICATION FOR SANITATION PERMITPermit No. ll (Complete in Duplicate) Date Issued ----- -x--- S Z2-2- - (CI-70- S� Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein d This application is made in compliance with County Ordinance No. 549. e 2,05- ---------. JOB ADDRESS AND LOCATI � ` ------------- Phone-------------------------.--•------ ----•---- ---- Owner s Name----------- -•-- -----� • ----------------------- Address------------------------ -------- Phone Phone.----•----------------------------- Contractor's Name ---------•------ Installation will serve: Residence QI Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ �� . ___ Number baths/---- Lot size �t`/- - } 1 -------- Number of living units: _I-___ Number of bedrooms - Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table ------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: Yes ❑ No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: 200 feet.) {No septic tank or cesspool permitted if public sewer is available within � �•f1�"' r Septic T nk: Distance from nearest well._Q__------Distance from fpundafion_ >�_..___.___..Mat�na4-,(� ._ -----�— 4 No. of compartments----__ _Sizer W---�/X-- -- Liquid depth--- -----------------Capacity_ �f-Q----------- T •�� '� } j6_�-#wA-*-Djstance to new lot line___S."- � Disposal Field: Distance from nearest well-_a_._ stance from foundation--/ Number of lines...---2x Length of each line#;- -- ----,--Y��Width of ch------- ,"--------------- - ------ - ----- Type of filter material__ epth of filter material_____ N_____.Total length----1�2 -0----.-------•--••• Seepage Pit: Distance to nearest well----------------------Distance from foundation-------------------- Distance to nearest lot line--- ❑ Number of pits------ ----- Lining material Size: Diameter Depth_ r LV Cesspool: Distance from nearest well-----------------Distance from foundation-------------------_Lining material--------------------- ❑ Size: Diameter---------------------r ---------.Depth--------------------------------- ------Liquid Capacity- _------gals. Distance from nearest well------------------------------------_________---Distance from nearest building_---_..__-________________________"___._- Privy: ❑ --------------------------- Distance to nearest lot line--------------------------- --- ---------------------- ----------------------------------------------------•- Remodeling and/or repairing (describe)---------------------- ---------------------------•---------------------------•------ ----------------------------- ------------------------ -------------•------ -- ------ ----- ---- --- ! hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules afregulations of the San Joaquin Local Health District. f' r - ----------------(Owner and/or Contractor) (Signed)_ " ----------------- Title --- -- - ---------------------------------- By: - - - --- -- x_ (Plot plan, showing size of lot, location of system in re-l-ati- - on to wells, buil-dings, etc., can be placed an reverse side). Olt TM USE O �Y DATE-- APPLICATION ACCEPTED BY---- ---- ' - - ----------- �-,- - ... DATE-------------------------------•---------------------------- BUILDING PERMIT ISSUED----------------------------- ----------------------- ------------ ------- - ------- DATE------------------------------------------------------------ Alterations and/or recommendations------------------------------------------------------------------------`-"-----'-----"----- -----------------------•---------•---- ----------------------------------------- ------------------ --- -------------------- -- ----------------- ----------- FINALINSPECTION BY-------- -- ------------- ------------------------------------- Date--- ------------ ------------------------------- SAN ---- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oafs Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California E5-4-2M , Revisea 1-57 F.P.CO.