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`61 .t e APPLICATION FOR SANITATION PERMIT Permit No, Do.S'� (Complete in Duplicate) Date Issued - I /5 Application 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 with County Ordinance No. 549. JOB ADDRESS AND LOCATION--------- /fpA al�14 ww r ` ----- Owner's Name--------- �. -- --- -------------------- --- --------•--- --------- --------------------------------------------- ------- ----•-------- ---------------- -------------- Address--------- Phone ---- ------------------ ----- '- Contractor's Name----------------------• I ------- --------•---- Phone � 4___�__ ❑ ❑ Other Installation will serve: - Resident Apartment I--lous�'�❑ Commercial � ❑ Trailer Court Motel ❑ Number of living units: N bar of bedrooms _ -.- Number of baths -t-_- Lot size --------------- Wafer - ' Water Supply: Public system Corinmun'ity system .❑ Private ❑ Depth to Water Table,__, -_rift. Character of soil to a depth of 3 fee+: Sand [] Gfavel ❑ Sandy Loam'❑. Cla Y Loam ❑ Clay ❑ Adobe - ardpan ❑ Previous Application Made: Yes No �' � ` ❑ New Construction:. Yes ❑. -No ❑ FHA/VA: Yes ❑ No L T ,PE-TF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) ep — Distance from nearest wei-----------------Distance from foundation : __.Material-No. of compartments -------------- ---------------Size_----------------- --- -------Liquid depth----------------- -- ---------Capacity------ ------------ spDistance m e from nearest well--W1i�.rDistance from foundation_ 6;�____---.Distance to nearest lot line_-__11.3. Number of lines-----Z-----_ 'Length of each line--- ----------.Width of.trench_ C�a'� Type of filter material-- _ -.1- ----- -- --Depth of filter material------ ��_----Total length �_ --------------------' Seepa)e Pit.- Distance to nearest well- _ g `-- Disfience"from foundation_- _f_-_-_•Distance to nearest lot.line--r _t.___ 6 Number of pits-°__/_-------_---Lining material Size: Diameter �r - . .. �--------..Depth -.� �------------- Cesspool: Distance from nearest well-----------------Distance from foundation---__----____•_ ) ❑ Size: Diameter- '---- - --- -- ---Depth--------- -µ --------- --------------------- --Liquid Capacity-.- A ---- -------gals. (� Privy: Distance from nearest well---------------------_-----_ Distance from nearest building---------- 171 i__ ❑ Distance to nearest lot line___--._._--- - ._ � �, f --------------�--------- ----------------------4--------- Remodeling and/or repairing -- _ .� -- ?l. .a'�. � `r ----------------- - ---- ------- = -----------------------------------------------•---------------f- ---------------- --- ---------------------------------------------- -- -- , G I hereby certify that I have prepared this applica+ion and that the work will be done in accordance with San Joaquin County x. ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. PAY A NIGHT. (Signed) --------------- ptic-Tank-Serv-ite__ - { rfle}---------------- {Ow r_-•an = r, Contractor) By--=-•�-------• a�_.><./�:N,l d r,[�r Ho 2-7x46 ne d/n Plat fan, showing size of lot, location of o�ystem�in relation to wells T' ----------- P 9 �,i`i�ldings, etc., an be placed on reverse side]. FOR DEPARTMENT USE ONLY - APPLICATION ACCEPTED BY---- --- ----------------------- _ I - -------- -----------------------•-------------- - DATE--- REVIEWED BY------- --- ------------------------ --- DATE = BUILDING PERMIT ISSUED-------------------------- --- Alterations and/or recommendations: A E ------------------------ --------------- ---------------- ------------------------ ------------------- FINAL INSPECTION BY:----- --- =_ Date = --- -------- - - __ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street Stockton, California 814 North "C" Street Lodi, California Manteca, California Tracy, California ES-9--2M,, Revises 1.57 F,P.CO.