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APPLICATION FOR SANITATION PERMIT .J� Permit No. ..... PPI) 4 (Complete in Duplicate) j Date issued -"��i�y' . Application is hereby made to the San Joaquin Local Health bistrict fora permit to c 1' This application is made in compliance with unty Ordinance No. 549. p construct and install the work herein described, JOB ADDRESS AND L C Tl , Owner's Name___ ---"-.. 4 Address-- . Phone e."_ •--"---:-----•----•---_ - ------------------------------------------- Installation - Contractor's Name-------- ---- ----. ------ ------------------•----•------•---- Installation will serve: - Residence E.r � ------------ ---------------- Phone.__.------•--,-•------------------- I Apartment House ❑ Commercial ❑ Trailer Court Number of living units: Number of bedroom's _- ❑ Mote! ❑ Other ❑ T ' Number of`baths �� Lot size _ � � Water Supply: Publics stem Y ❑ Community system - --`""-""----"""--------- Character of soil to a"de`+h of 3 feet: Sand ❑ Gravel ❑PrlSand ❑o�Depth to Water Table _ { -- p 1 Y ❑ Clay Learn [] Clay ❑ Adobe Previous Application Made: Yes No Hardpan ❑ ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes 'No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well_11+� T ` Distance from foundation /� t" A� :: No. of com artments"_-- 1 Material_`-_ _- UIl p Size- ------------- �� --��----.Liquid depth-----�/_�- -- --- -- Disposal Field: Distance from nearest well Capacity_.""'Pi�_� 04 � istance from foundation_-f�_-___•"""-pistance to nearest I f Ifne-___ I!� Number of fines----__-_ -- Length of each line.""" = ---- a Width of trench---- !i Type of filter material"�� ___ Depth of filter material F / - --------------- Seepage Pit: Distance to nearest ell"__ -------------Totaf length----/ "Distance fro�oun' tion___.'Number of pits ---.Distan to nearest lot line"_-----------Lining material /ze: Diameter_y?,' � esspool: Distance from,.nearest well-------------- Depth------ --------------- El - Size: Diameter_"*-� -_` istance from foundation- ----------- ------ ming material-- ----- �------ --------------•-----., Distance Privy❑: Distance.from nearest well--- --_ -4#---_D� t `""" "" ___-. ---Distance Liquid Capacity------------------------- Privy: gals. \3� from•nearest building to nearest lot Ione - y - . . - .�^ Remodeling and/or repairing (describe):---------- -- �/, ------------- ----------- --------------------------------------------------------------------------------------------------------------------------------- --------------------•------•--•------ ------------------ ------- --------------- ------------•---- = -----------•------------------------- --------- I hereby certify that I have prepared this applicatiom and that the work will be done in accordance with San Joaquin-County ordinances, State laws, and rules and ' ' uI tions of the San Joaquin�Loca ealth District. (Signed)----------- By:----------------------------- By:----------------------------- ----- Contractor) ( p j y -- --- -----•----------•-----------------------(Title) 9 ion to wells, buildings,.etc., can be placed on rev � Plot plan, showing size of lot, loc n of system in.rale+ e FOR-DEPARTMENT USE ONLY APPLICATION ACCEPTED BY - DATE. • REVIEWED BY_ •-•---------•-------------------------------- ----- ----------- BUILDING PERMIT ISSUED-------------------------" - DATE. "-_- . Alterations and/or recommendations: ' — DATE --- S'_ I ----------------------•-----"-------------•------------- - -------- f ----- --------.-Q. �e�.y. , ; ------- - ---- ----- --------------------- - --- -------------- - - - ---------------------------------- ----------------------------- :r �,. =------------------------- --------------- -------------- ------------ -° _ FINAL 'INSPECTION BY:.-- �,.�� Date......:-7_~__l.S SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street t 300 West Oak Street " A i32 Sycamore Street s +� t Stockton, California t" Lodi California 814 North "C" Street * Manteca, California Tracy, California ES-9-2M Revised 1-57 F.P,CO.