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Permit APPLICATION FOR SANITATION PERMIT (Complete in Duplicate) Date Issued-�_. ___7-5.V it to construct and install the work herein described. Applica+ion is hereby made to the San Joaquin Local Health District for a perm This application is made in compliance with County Ordinance No. 549 ----------------------. JOB ADDRESS AND LOCATION---- c`' ------- -------------------------- Phone------------------------------- Owner's Name----------• -------- ---------- -- --- Address---------------- ---- �Q Contractor's Name " ------- er ial ------ Phone_, D 6-=---6- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Mofiel ❑ Other ❑ i Number of baths __�_- Lot size ----K57-_ ----------------------------- Number of living units: _ ___ Number of bedrooms ..� � Water Supply: Public'system ❑ ' Community system ❑ Private Depth to Water Table'/g- ft. Character of soil to a depth of 3 feet. Sand ❑ Gravel ❑ Sandy Loam ❑F Clay Loam ❑ Clay ❑ Adobe ff-"'H ardpan ❑ Previous Application Made: Yes ❑ +No New Construction: Yes �o ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: vailable within 200 feet.) (No septic tank.or cesspool permitted if public sewer is a Septic Tank: Distance from nearest well_SO_--__-- is ante from foundation__A�_` .----.Materia!__________-__________________ _______________�.Q Size_3—X X--�---------------Liquid depth-- ��-- -----------Capacify...-�Q? - ----- L7 No. of compartments_-"--- ----------- Disposal Field: Distance from nearest we{js�� istance from foundation__Z�- -.--.-.Distance to nearest lot line____.-___S� Len th of each line------75----=YO�--W,dth of trench.--- -y--------------------- ' Number of lines---------------- ------- - ----- g .i � � Type of filter material-_t�kRA-GA(.__'Depth of filter material___f/ ---___-----Total length_____-- ------------- Seepage Pit: h Distance to nearest well____________ '___Distance from foundation__-____-____.._.___Distance to nearest lot line----------------- Number of pits----------------------Lining material----------------------.Size: Diameter Depth CesF oI Distance from nearest well________________Distance from foundation---.I---_.__.__._--.Lining material-_.__--_____---.--------------- els. Size: Diameter Privy: Depthlb ----------------------------- ------------------- Liquid Capacity $ ❑' Distance from nearest well-------------------------------------------------Distance from nenearestbuilding----------------------------------------- 1 ❑ .: .. Distance to nearest lot line-'--------------.-------- ---------------------------------------------------------- Remodeling and/or repairing (describe _____________________________ ----------------------- :. ----------------- -------•---------------•--------------•• --•------•-----•-------••----...------------------------- ------- ! I ---------•------------------------------------- ied this ! ordinances,hereby-certify have application the San JoaquinhLocalkHealthleDistrictn accordance with San Joaquin nun (Signed)---- � ------- -- ----- -------------------- ----------------------------- er and/or Contractor) ' sY= �-------- --------------------------------------------------{Title)---- (Plot plan, showing size of lot, location of syVem in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY r --------- ---- DATE------- ;----------------- APPLICATION ACCEPTED BY---- -- -�--�-::------------`------- ----------- - DATE_ REVIEWEDBY-------------------------------------------------------- - ------------------------------------ - --------------- ' BUILDING PERMIT ISSUED------------------ -------------------------------------------------------- DATE.- ------------------------------------- -- Alterations and/or recommendations:. ._____.______________________._____ ._ --•------•-------------••---•-------•--------•------•----------- - ---•---------------- -------•-----------•------------- -----._ --------------------------------- .- ------ ----- ------------------------------------------ -------- - ------------• ------------.-----•-- Date FINAL INSPECTION BY:--........ -r-- --------------------- il SAN JOAQUIN LOCAL HEALTH DISTRICT 30o West Oak Street 132 Sycamore Street 814 North "C" Street 130 South American Street Tree California Stockton, California Lodi, California Manteca, California ri