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r- ''� APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) > ,! � 7 ` ate Issued ._ v� Application is here d� h ` y ma a to t e San Joaquin Local Health District for a permit to c ns7uct an s all th wo rein des rib d. This application is made in complia ce with C my O finance No. 549 ' JOB ADDRESS AND LOCA o' ; -- - - ------------- ----- - - --- --- Owner's Name' -- -- - -- ' Address-----•--------••---•----`------- - ----�`- ------------ ----- hone. p Contractor's Name_ ► •--------------•--- i - Phone__.-- --•--- ----- ; Installation will serve: Residence � Apartment House [� Commercial - '� Number of living units: _ ❑ Trailer Court ❑ Motel 0 Other ❑ Number of bedrooms ___�__ Number of _ Lot size Supply: Publics stem --3; ` _______❑ Cny system Private De;;C`L,�VLO r Table ;Character of soil to a depth of 3 feet: Sand ravel ❑ Sandy Loamam +Previous Application Made: Yes No ��!' ❑ Clay El Adobe❑ Hardpan [] ❑ New Construction; Yes L�I�o U TYPE OF INSTALLATION AND SPECIFICATIONS: Ik (No septic tank or cesspool rmitted if ublic sewer i ay �l„a 1p_w'thi�Oof .) Septic Tank:, Distance from res, we.l _ q�s❑,� No.•of compartments---------- - SDizean__e o _ fondLigwd de ----- --- a`terial----I l-----------------•-- Dis osa Fie / --- ---------Capacity------ P �!'`� Distance from near t wel'_y_1_ Distance from'foundation__ //.'sem / ------___.Distance to nearest lot line"---" ---_� Number ai lines___ _ " Length of each line"___ _ /` - ` Width of trench---- -- -- Type of filler mafierial4, 02� _ r Depth of filter.material �� ��:_ Total length--- *page ----------- 5eepage Pit: Distance to nearest well --------------------Distance from •foundation____________ ______ ❑ Number of Pits---°_- ---_._ Distance to nearest lot line_________________ Lining material----- ------------Size: Diameter-------------- Cess Cesspool: i Depth- p Distance from nearest well. ---------------- from foundation--- material-_---_-_"."______,_-""_"_ 1 ❑ Size: Diameter__" _r___. _ _ -De th------- _t _—._T�, . �. t i uid .� .� -- - q Capacit _ ---- rivY: Distance from nearest well------------------ Dish _ _`' � Y ;------- El —-gals— """----"""- ante from nearest building--------------------------------- -------------- ❑ Distance to nearest lot line-------- -_" - -- ----- ----- ------ -----------------/ -------------------------_1----------------------- Remodeling and/or repairing (describe)_* ------------ ---- -------------•----.---- ------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin------ -------------------- ----- --------------N---- ordinances, State ws, nd rules and regulations of the San J aquin Local H • - uin County ealth Districfi. + :. -- --------- By:--------- ---- ontract --- -. O er and/or . ------------ ---------------------------------------------(rifle)-- ---- (Plot plan, showing size of of, Iocafion of system in relation to wells, buildings, efc., can be placed on reverse-side). I FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY___._______._.._"________.__ -------------•-------------- DATE-------- BUILDING PERMIT DATE REVIEWED BY --------------------------- --------- � -----------�-�-"-�-��- ------ �. ISSUED----------------------""_- ---"""--- --------------------- DATE -------- Alterations and/or recommendations_ ------ I --------------------•--------- ------------------------ -•--•-- I ------------------- ------------------ ----------------------------- -------- -------------------------------- ------------------------ -- ---------------- FIIKIAL INSPECTION BY:....... ._ """a-------------------------- Date. -- - ------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 Wes+ Oak Street Stockton, California !32 Sycamore Street 814 North "G" Street Lodi, California Manteca, California Tracy, California ES-9-2M 10-52 Revised W-2100