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i APPLICATION FOR SANITATION PERMIT [Complete in Duplicate] Permit No. Date Issued Applica+ion is hereby made to.the San Joaquin Local Health District for a permit to construct and install t This application is made in compliance with County Ordinance No. 549. �� he work herein described. JOB ADDRESS AND LOC ISON 1." 2_ coo, c . Owner's Name f t ['1.------- ------------------ ----------- r �_ Address_•:_--------- = --0.-. ----------------------------------- Phone a ZJ "• "�_ Contractor's Name--- - :------------ ----------------------------- Installation will serve: 'Residence i. Phone'e0 6 �O Apartment House ❑ Commercial � ---'""""�`-'-->7• Number of living units: ��munity ❑ Trailer Court ber of bedrooms ❑ Motel ❑ Other�""_ Number of baths � ._ Lot size _____� 0 �Water Supply: Public'-system system --- acs o ❑ Private ❑ Depth to Water Table ft i Charac+er of soil to a depth of 3 fee+: Sand Gravel Previous Application Made: Yes ❑ Sandy Loam ❑ Clay Loam❑ Clay ,�,� ❑ No y ❑ Adobe 3 Hard an TYPE OF INSTALLATION AND SPECIFICATIONS: Yes [] No ❑ 0 (No septic tanksor cesspool permitted if public sewer is availablewithin 200 feet.) ,(1 .~ Distance from nearest wellDistance m n e -.-"Distance from f' 'NO"- Material__, "_-___-_ NO' Of compartments-�_'�------# " " Size__`__--- os , F' Liquid depth----- ----- -- C Distance from nearest well "Distance from foundation--- 'a aci p tY ' Number,ofi'lines------------___"-_""_. .------Dis#ante to nearest lot line"__________""""_ `Length of each line----------______•-" ""_- Width of fre' h. Type of filter material-""_____ _--- ------Depth of filter material._________- eePa_9ti Distance to neare t'wellr4`►v.� Total` length-------------------------------•----�-- _Disfianc"Ifromounda#ion"".1 _!"" Distance to nearest lot fine 'f Nu bar of --------------pits.----� Lining material._ Size: Diameter- Cess ool: r� De th -- p Distance from nearest welt--------------- Distance from foundation._.- _"" _ "Lining materialp__."___ ❑ [` ` Size: Diameter_-"-- -____" -- (, _t, s Depth - ----- _ `v Priv ...... Liquid Capacity------------------------------ Y�. ' Distance from nearest vre►I-------------------------------------------- - " Ygals. �1 ❑ � ---Distance to nearest loft line--"_-�_.-_ . Distance from nearest building 1 ------------ ---------------------- - Remodeling and/br repairing (describe): -------------- ---- --- ii i ----. -- ------------------------------------------------------------------------------------------•-----•-"-------•-------------- --------------------------------------------------•------------------- I hereby cert; t a have prep rad this application and that the work will be done in accordance with San Joaquin ordinances, State laws'an rules an regal 's of the San uin ocal alth District. qu�n County r q (Signed)-- ------------- By:.--. ----•------ ['� -- -- --- 1--- '� Contractor) d o+ plan, showing size of lot;location of system in relat' n o wells, buildings, a c., can be placed on reverse side). ----- --------- fY1_ Q. -------------------- � . 'j. FOR DEPARTMENT tJSE ONLY APPLICATION ACCEPTED BY-------------------------------------- REVIEWED BY---------------- --------------------------------- . DATE- - . ----- ------------ � --- --SQ AlteralNG PERMIT ISSUED------------------ " DATE---•----------- BUILD --•-- '------•------ tions and/or.recommendations:-- - DATE ------------ ----------------------- p --• - --•--- - ----------------------- -- _ - --------------------••------------------- --••-------------------- -----------------------------•--- --- " --------------- -------------------------------- FINAL 1lVSPECTION BY: S ---- Date7 a ------- ---=- 130 South American Street - SAN JOAQUIN LOCAL HEALTH DISTRICT ' 300 Wes+ Oak Street 132 Sycamore Street Stockton, California Lodi, California 8i4 North "C" Street Manteca, California Tracy, California ES-9-2M Revised W.21()()