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APPLICATION FOR SANITATION PERMIT "' (Complete'in Duplicate) Permit No. r.� Application is hereby made to the San�:loaquin Local Health D' Date .Issued -_ .fes. r This application is mad District for e rn compliance with County Ordinance No..5 g. a permit to construct and install the work herein described. �I� JOB ADDRESS 41LO(;ITION ' ! � --0 - --- a. Owners Name-- ----C_j �Address_-----..c" - ------------•-------- Phone. ^� r �--------- Contractor's Name.._ -' ---------------•--------------- •-- ----- ------ - -- ---- Installation will serve: Residence ` Phone. - —_ Apartment House 0 Commercial ' Number of living units: _.. -_ ❑ Trailer Court ov ❑ OfHer� ❑ _ Number of bedrooms ._ 7 �u Number o aths ._1--• Lot size .... / Water Supply: Publics stem -;--- 1-1¢2_I---- Y ❑ Community system --•-----.--:F �., Y Y ❑ Private 'Depth to Water Table _.._-- ft. Character of soil to a depth of 3 feet:. Sand - Gravel E] Sandy Loam ClayLoam ,� / Previous Application Made. Yes ❑ Clay ❑ Adobe Lld"riardpan ❑ ❑ N New Construction: Yes � No/0 TYPE OF INSTALLATION AND SPECIFICATIONS: t P (No septic tank or cesspool permitted if public Seewer is available within 200 feet,) f ptic ank: Distance from nearest well. ✓ Distancg frogi faun tion._-.. No. of compartments- Mat ill ---:�--- Size0__\ F. ' Liquid th_ ��rrld �' Capacity... Disposal arid: Distance from nearest weil.. �____--_Distance from foundation_4 ZI_Distance to nearest lot line Number of lines---------- -- 10 1 . Length of each lin -`--- _ t f �-•--��-e-e----- Q '� ----"-- Width of Type of filter material.___/&_ -Depth of filter material__-_ . / Seepage Pit: �--------------Total length----____-- -_ __r__"_--------- --------------- _____ __ Distance to nearest well__-._._--------------Distance from foundation.____ - Number of pits--------------- Lining material----------------------- ----•-------..Distance to neareWlot line.------------- Cesspool: --- •___ t Size: Diameter ----------------- Cesspool: Distance from nearest well-----------------Distance from foundation.._..._-_--_ Depth._.___._..._____._.___- • ---------- � . ❑ Size: Diameter-------------------------------------- ------.Linin material-----------•-_-• u -... Priv""""- . Depth------ Lining _ Liquid Capacity. Y= Distance fro ne`Wres _ g s ------ --- �ista�itZ'*fr --- al Distance to nearest lot line_. ears Ing___..--------------------------- emodeling and/or repairing (describe}------------- ---------------------------- ----------------•--------- ------------------ --•-- --------••- ------•---------------------------- ---------•----••--------------- . PP :. hereby certify that I have re ared this a lication and that t - ---------------`---------••-- ---- ordinances, State laws, and rules and regulations of the San Joaquin Local Health eDi trice. accordance with San Joaquin County (Signed)----_ ? t " C ------- --------------------------------------- __ � {Owner and/or Contractor) (Plot plan, showingsize of lot location of system in relation ------------------------------------------------------ ---- ------------------------------------(Title)__ -- side).--- to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY.._._-- . ----.------------- --------------------•--------------.------- EVIEWED BY---------------------------------------------------- ---------- �- DATE------ ------- ---�.�. �� BUILDING PERMIT ISSUED-------------- - - ----------- Alterations ------ j . DATE------------ _ - ---------------------------------------------------------------------------------------- A aeraaions and/or recommendations:.._---- -_ ------ ----___ _ - - BATE - ---------- - ------- - ----- ------------- --- - ------------- ----------------------- ------ C ------------ ------------------ ---------- ------------------- ----------------- - ------------------------------- ---------------------------------------------------- - - -------------------------- FINAL INSPECTION BY-------- ------ -- f/ !cS Date- ---------- -� ------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street132 - �_ Stockton, California i, California Manteca, Celifornie Sycamore Street Lod814 North "C" Street E5-9-2M 8-51 Revised W-2100 Tracy, California +' r