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k — �— r APPLICATION FOR SANITATION PERMIT Permit No. .._�_S�1`.!_.. (Complete in Duplicate) � cLo4=5 f-1'nll C� 1� �, Date Issued ___0/1_R_J7 pplica{ion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance w-th County Ordinance No. 549 t JOB ADDRESS A CATION.. _ �.. -.._ . -- -- 4- S -- --------------- Owner's Name-- -------- Phone--- -------- ------------------------ Address-------�L_0_1 Contractor's Name --------------------- Phone__.. Installation will serve: , Resident Apartment House ❑ Commercial f] Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _�_____ Number of bedroom/-_ Number of baths --)----- Lot size _--).77----A-. T(- Wafer Supply:4 Public system ❑ Community system ❑ Private Depth to Water Table&_� ft. ' Charas#er of soil toe de th of 3 feet: Sand Gravel Sand Loam Clay Loam Clay P ❑ ❑ Y ❑ y ❑ y ❑ Adobe�Hardpan M ❑ Previous Application Made: Yes E]} No� New Construction: Yes E] No� ,— TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permifted if public sewer.is available within 200 feet.) Septic Ta k: Distance from nearest well________________Distance from foundation----------------- _-Material------ s-...-_-.-_.__..._- -____.--------------- No. of compartments Size Liquid depth------------------------ -Capacity Disposal Field: Distance from nearest well._ _ Distance from fcundafion___-_ _\/._____.Distance to nearest lot line_____ ________ '� 1 Number of lines__---_____ _ Le th of Fach line----I ---�----- Width of trench �'® - ----- ITy�e of filter material- 44146rmaterial--__ ----.._ __ - �- Total length------f_ --------------------- Seepage Pit: Distance to nearest well ___. __b._61--f.-Distance from�founda ionC-j__S-).�____.Distance to nearest lot line___ _____ Number of its------ g - --1 Y':Ew Diameter__.-. - -----De-fn-..._-- P I--------------Linin material P Cesspool: Distance from nearest well_________________Distance from foundation------------------ Lining material_----------------------------------- -------- __.._.___---__.______-_---____-. 4 . ❑ size: Diameter -------.Depth---------------------------------------------------Liquid Capacity ------------------ 9aIs.k Privy: Distance.from nearest well.......:............. --_________Distance.from neares+'builalin ----------------- Distance to nearest lot line________ _------------------_-_------- _ ----- - -•--- Remodeling and/or repairing (describe):__.67��, ------ --_--- ------------ f --- IF ------------------------------------------••-------•-•------------------------------------------------•---------•--------- -------•-------------------••------- - t f a -- s I I hereby certify that I have prepared this application and fhaf^fhe•work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed)•-•-------- , � t ------- -- -- - --------------- ---------------•-------- ---------------{Owner and/or Contractor) By;------------ --=--_ (Title) ---------------- -------------------------------------------------------------------------••------ (Plot plan, showing size of lof, location of system in relation to wells, buildings, efc., can be placed on reverse side). � e FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -------------- DATE----------------------------- BI11LlD NG PERMIT ISSUED DATE---------------- �----------------------------•------ --------------- -- --------------------- ----- DATE........Alterafions and/or recommendations_________________._. ��. ------ •------------ 1 --------------------- ------ r, _-__...__-_.______________________________ __ k FINAL INSPECTION BY:_ �----- ---------------------------- y _ --�-� Date_..:_ SAN JOAQUIN LOCAL HEALTH DISTRICT 30 South American Street 300 West Oak Street i 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California` 'S` Manteca, California Tracy, California 454 -a AO o: �-124'x•,