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I ik APPLICATION FOR -SANITATION PERMIT Permit No. --�-_�••/ (Complete in Duplicate) Date issued Application is hereby made to the San Joaquin Local Health Di Thiszapplication is made in compliance with Countolly Ordinance strict for a permit�t0 construct and install the work herein described. z. JOB: F . 54 : iADDRESS AND LOCATION_. .__-- "' � --• -- Owner s, Name -----• Address= r Phone 1,� n 1-� 22 --------------- ~ ---- - - Contracfor's. Name `t •---------••---------------------- - -- ----------u0_u h_ '- Installation will serve:_-Residence,f -------------- -----------------------------------------•-- Phone.__......__. Apartment House ----------------------- . . •+•� ,.,._z.,� ❑ Commercial ❑ Trailer Court ❑ Motel Number of lry+ng units: __�,-- Number of bedrooms .2- t ❑ Other ❑ Water Su I ---- Number of baths . __ pply. Public system Community system Lot size _ -__-_� 11 (� -l- - t ------------------ i Private p Character of soil to a depth of 3 feed YSand Gravel Depth to Water Table�_0!ft, e, Previous ApplicationMade: Yes k 1 ❑ Sandy Loam Clay Loam ❑ No New Construction: yes y ❑ Cfayf[] Adobe Hardpan ❑ TYPE OF INSTALLATION AND SPECIFICATIONS.: o ❑ Li ECIFICATIONS.: F` (No septic tankor cess`poal permitted'if public sewer is available within 200 feet.) Septic nk: Iv- Distance from nearest well_____ ___-_____ Dista ce from found fiion_____ r No, of compartments_-_.____ - -----_Material_ ��e ------size_ -[ A.IQ- F Dispose Field: Distance from nearest.we 1_____.____-_---_Distancrom foundation---�/ quit i depth -_ { ---- . -. . Capacity , \ Number of lines_________-__ c7-- -----Disfiance to nearest lot Ilner_-___.__ Length of each _ f __ F` line---- Type of filter material__-__CJ dC } . __.Width.of trench. .___ ----- Seepage Pit: # I (_Depth of filter material,_-._-__ -_ tFDisfance to nearest weft----- Total length___.____.-/_�_ -- 7(� ___.____Distance from foundation___________________,Distance to nearest lot line-------------- Cesspool: ❑ Number of-pifis._.� -- __ Lining material--- ------ :--..Size: Diameter----•_ Depth 1 t t a i = _ --.D Distance ft- nearest wel! ________ ___Distance from foundation Liningl'mate�ial__.-__-_�___ ❑ Sire: Diameter_--- fr-•- .+ �� Depth.. i Priv _ s y' Disfance from ne St.�ell�' "__ �-' L+quidCapa{ifY= _ gals. Distance from nearest building- --------- ❑ Distance to nearest lot line._: T Remodeling and/or epair;g (describe): ,. ...........................- _ ------- ----------------------------------------------------------- ----•- -• ------,_. --------- = _ --- -- } t # ----------------- -1 ------------ . ----------- ------------- -- - -------- ---------------- -------------- _- = ---- ------ :i ------------- -- ------I----------------------- I hereby certify that ! ha e prepared this application and that the work ivifl be done in accordance with San Joaquin ' ordinances, State laws, and ru9es-and. of the San Joaquin Local Health District. (Signed)_ County ----- ----- _. By.. – + .------ -- caner ---- (Plot pla , showing siz - - -------------------- -' and/or Contract - ,, ,:°=---- �`-=----- ---- ----------------------- ------ --------------(Title)------ ----- -- - ----•-- ---- 9 lot, location of system in relation to wells, buildings. etc., can be placed on reverse side). F R DEPARTMENT USE ONLY APPLICATION ACCEPTED•BY_- T . REVIEWED BY -- ---------------- - -- --- --- -----=-"===� - -_ --------. DATE - -- ----------------------------------- BUILDING PERMIT ISSUED---------------- �-- Y --------------------- ---------�""DATE -�-_�-- � - -< -----•------ -------------------t D aerations and/or recorn ns:_r :�,-'"; `� a �" A - ---- ._ �- ------ �/ i -- -- - -- ---' - __-- ------ ... s A ----- - ,' - " _ � --mss sr �r 1 � f- -- -------------- -- --- _. —- --------------------- FINALINSPECTION BY '* JZ Date -` QUTN LOCAL HEALTH DISTRI Tf5 ' lG/ ��• 130 South American Street '' 30 Wes} Oak Street'' 'Stockton, California. 132 Sycamore Street r«aTS Street d ' 8i4 N '`�'. Lodi, California Manteca, California orth C" 1c5-9-2 l0- Tracy, California M 52 fjeyised W-2f04: _