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APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) Applica+ion is hereby made to the San Joaquin Local Heap Date Issued This application is made in compliance with County Ordinance'rNoc54gr a permit to construct and install the work herein described. I JOB ADDRESS AND LOCATION p Owner's Name --------------------- ------------••------•---------------- ------------ ----------•- ----------------------------- --- ontractor's Name---- _ _-�,�_ - _ Installation will serve: Residence Z Apartment House ❑ Commercial Phone- �_� � � 7 Number of livingunits: ❑ Trailer Court ❑ Motel ❑ Other ❑ /----- Number of bedrooms ---'-- Number of baths _ Water Supply: Publics stem ------ Lot size --C- f��e_ e Y Communit system ----`--- ----•- Y Y ❑ Private ❑ Depth to Water Table C-c� ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Previous Application Made: Yes ❑ No C] Clay Loam E3 Clay F-1 AdobHardpan ❑ �_ New Construction: Yes � No E] e TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ` Septic T k:-� z p Aance from nearest well--.--_----------Distance from foundation_.------_-__- _--Material________________ ❑ "IElof compartments--- Size- --------- -----.Liquid depth----------------- --------Capacity------ isposal Field: istance from nearest well--------- ------Distance from foundation-------------------.Distance to nearest lot line---:-------- _ ---------------- ❑ er of lines-----------------------------------Length of each line---------.-- -Width of trench------------------ ----- T e of filter material----------------------- Depth of filter material-----------------------Total length------•--------_------ r Seepage Pit: Distance to nearest well-_ -V . / - , �1=L�Distance f o foundation-'- Number of pits-...'- _- �� Distance F`nearest lot line--. ------ -----Lining material r� t , , ----- ameter .- _.�_De to-_. Cesspool Distance from nearest well-----------------Distance from foundation..-.-.-_-__-- p � material Size: Diameter--- �------ ------- �----- �-------.Depfih------------------------------ ------ ------ -------Liquid Capacit .-.------ ------- y Privy: Distance from nearest well------ - --- Distance to nearest lot:line.._-- ^� I ---------------Distance from nearest building---------_-_---------------------------- ❑ __ ----------------------------•----- I t Remodeling and/or repairing (describe)---------------------------------- i ------•--•----••------------•--•--- ------------•--------------•--•--•-------------- ------------------•--•• v! ------------------------------------------------, I hereby certi that I have prepared this application and that the work will be done in accord an r - ordinances, State la s, and rubs and regulations of the San Joaquin Local Health District, ce with San Joa uin Court ,# (Signed). - --- -------- --------- B -------BY• -- ---- -----•- � ----------------------------------------- - r Confractor -(Owner and/or (Plot plan, showing (Title)size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED. BY--------------------- ------------- ----------------- ---------------•-------•--------------. REVIEWED BY ---- ----- - BATE ----- f4 d ---------------- UILDING PERMIT ISSUED. --------- ----- ------ DATE----------- --------------------------•----- -------------------------------- Alteratians and/or recommendations:_- - bATE--.-_---�---�--------------------- --------------------- N . -•------• - •--•--•---•--- •-- FINAL INSPECTION BY:.-- - - --- -------- ---------- Date--'-.- -------- ---- --- -------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street Stockton, California Lo134 Syeemore Street 814 North "C" Street di, California Manteca, California Tracy, California E5-9 145446 ATWOOD