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e Permit No. _.__f APPLICATION FOR SANITATION PERMIT . _ {Complete in Duplicate) 7 / Date Issued Applica+ion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordina ce No. 549. JOB ADDRESS ACATION-- = - -- - Owner's Name l r L ---------•. •------ --�-'.�'" --- '-------- - Phone_ ----f--�--- Address- . .. - ---------------------- -- ----- - �+_.�. Y Contractor's Name----------------- �} ._ :, Phone .: "'_�� Installation will serve: Residence Apartm ouse ❑ Commercial ❑ Trailer Court ❑ Motel Other ❑ Number of living units: _/---- Number of bedrooms_ Number of baths -_._.-.- Lot size Water Supply: Public system Community system ❑ Private E] Depth to Water Table.�- `ft. b Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Ad ob Hardpan ❑ Previous Application Made: Yes ❑ NOX New Construction: Yes [I 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_________________Distance from foundation________.__.___-__.Material-_________._._____.._______._______-____..___._. . • ' . No. of compartments--------- ----------------Size------------------------__---Liquid depth----------------- ------- Capacity-------- - -------- Dis osa ield: Distance €rom nearest well....______. Distance from foundation______--_.____.._.Distance to nearest lot line_________________ :�� Number of lines-----------------------------------Length of each line----_.------------------- _ ------Width of +ranch-------------------------- -------- IS of filter material_________________________Depth of filter material_._.____-/efer- Nurhb&r Lal length_______.____-_______--______________---._ � E Seepa e Pit: Distance to nearest wef1_,,� -___Distance from Yundatior r "Distance to nearest lot he____—� of pits,---_- .............Lining materia1;.f ___./�`-----Size: Dia _.-�V_ _!L.Depth.. _ Cesspool: Distance from nearest wefi-------------_---Distance from foundation._.---_-------------Lining map..__-.----.-----------......................... �`1J ❑ Size: Diameter-------------------------------------Depth---------------------------•----.-------------------Liquid Capacity_--------------------------gals. �V Pr-ivy: Distancejrom nearest well----. ------_------------._---------Distance from nearest building_.__.__.____-.___________-._._._-..____._. ❑ Distance to nearest lot line--------------------------------------------- _ Remo- tiling and/or rep ag—(describe :-- _ r C_ _ ....- `' _-- ; _- f --_-- _ --------------- .`___________ s�...- ---------- ------------------------------- -- _ ------------------------ _-_.___ -.________ -____.____ __________.-._____--_____________--_-____.____ .. �+ -- ��-'�---------------------------------------------------------------- --- ------------- -- -------------------------------------------- - ----- -- 1 --------•-------------`------ --------------------------------------------------------------------------- -----------------------------------------------------------•-- -----•----------------------------- ---•----- I hereby 'rtify that I have prepared this applicationand th f the work will be done in accordance with San Joaquin County a ordinances, State laws, and rules,an egulations the sn Jo/quip Local Health rict. (Signed) r ^ r Z =� ---- -- --(O a d/o tract -�- __ w r_Con or) By: ----- -- ------;--.�_- - - �- .�� ----�--------- - --- - •- -----(Title�,.�r�- .•to---- - (Plot plan, showing six ofrio la n sys} n relation to wells, buildings, etc., can be placed on re4ers J FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----------- -- - ----------- ------------------- DATE---------- -- ----- , - - --------------- ----------------- BUILDING --- -- - , ;7------------- DATE REVIEWED BY ----------------- BUILDING PERMIT ISSUED-------------------------------- ------------------------ - ------ Alterations an /ocommendations_________________ a _ y�.;-------------------------------- ---------------------------------------------------------------------- -------------------------------------- FINAL INSPECTION BY:....... ------ Date-- -- --------- --------------------- ANOA UIN LOCAL H ALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California E5-9 145446 ATwooa ��