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APPLICATION FOR SANITATION Permit No. (Complete in Duplicate} G"" r . ..� . _ _ Date Issued !` �j Application is hereby made to the San Joaquin Local Health District for a permit to construct and stall the work I This application is made in compliance with County Ordinan No, 549. herein described, JOB ADDRESS AND L / ATION-------"--/- 7XI - --- Y i Owner's Name - --- - -------•-----------------------------------•----- Address_. -•-------•"" i Contractor's Name--------------- � • -� Phone/•-_____-__-._ ------------ --------------•-----------------------------•------------------------- ------------------------------------------- 1__' --------•-•--------------------------- Installation will serve: Residence �� -----------------------------••-----•--`-• --'`------- ----------- -- �� 'f�a7 Apartment House Phone" Number of livingunits: _ Commercial ❑ Trailer Court ❑ Motel ". Numfber of bedrooms -02- Number of baths .-_� ❑ Other ❑ Water Supply: Public system �� Lot size _--"5�------" X �S� ommunit system"Y Y Privafe' De- � """---------- Character of soil to a depth `of 3 feet: Sand ❑ pth to Water Table So {t, ❑ Gravel ❑ Sandy Loam ❑ Clay.Loam Previous Application Made: Yes i Y. ❑ Clay ❑ Adobe [ }-Hardpan ❑ � ❑ No (�rNew Constructi-ori: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) S is T sk: Distance from nearest well_---------------Distance from foundation------ No. of compartments------------` Material ---------------------------------- ?. Numb ------------Size------•--------------------•----Liquid depth.- Capacity D+s asal Fie d; Distance ofryom nearest well--..-_"__.:____._Distance from foundation___"-, ---_""_-.-Distance to nearest loline""_""-."."".__ p lines---- ---- --------- (/ Length °f each fine ----.Width of trench- ype of filter material------- ------------ - -Depth of filter material-""_- "." Seepage Pit: Distance f s ry, x Total length-------_-- o nearest well".!"�i'M,2.J - Distance^f`a fo dation "1Q._- Distance to nearest lot line-_ -_�___ Number of pits_------ i Lining material:-- �i Size: Diameter-- De tri. Cess dol: f p _--_- p Distance from nearest well" ---_Distance from foundation material------- ---------------------------. � ❑ Size. Drameter._ Depth------- ------------------------------- Privy: -- -- ------ ------ -- ----- ---k Liquid Capacity rivY: Distance from nearest well"-_-._." _____-_ :---gals. --- ------------=--------Distance from nearest buildiri ❑ Distance to nearest lot line_-_"'-'"-._- - g --------- ----------- {i a ---"_-- z ---------------------------------------------------------------------------- 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 Count ordinances, State I ws, and rule's d regulatiioons of the San Joaquin Local Health District. County (Signed) 3 =� --- -- Y ------ ---- Owner and/or Contractor} Plot Ian, showing size of lot, to - - - ----------------------------. • -------(Title)----- --- t- p 9 cation of system in relati to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY__!'_. REVIEWED BY - - --------------•----- DATE_--- -------------------------------------------------- ISS ------------ BUILDING PERMIT ISSUED-". ------ DATE-------------- ------------------ - - ---------- •--------------------------------------- DATE------ f - Alterations and/or recommendations:.-_-"-. ------- --------_- __- "-"""__ ".__ 4� .."" -------------------•--------"'----------------'-------•----•--'-•"-------•----- ^-1------..-------------••----- -------------------- ------1 .----"-. -- "" ---- ------•-------- FINAL INSPECTION B ------------------ -- Date - ----------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 134 South American Street 300 West Oak Street 132 Sycamore Streefi 814 North "C" Street Stockton, California Lodi, California i Manteca, California Tracy, California r5—"9_2M iasa<e Arwood �z-sa