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APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) Date Issued A p Wi �i3' 461rl6y' 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 Ordinance No. 549. cl)/-,&Z �0,.Z( a e JOB ADDRESS AN ! CATION- Phoneji--Or<7- --- ---------- Owner's Name------- ----------- -------- ----- --------------;;ii---------- --------------------------- ...... ------------- ----------------------- Address , % A Contractor's Name------ ------- --------------------------------------------- Installation will serve: Residence [BApartment House E] Commercial El Trailer Court E] Motel [j Other E] Number of living units: Number of bedrooms i;�� Number of baths --4 Lot size ...--------------------------- Water Supply: Public system 11 Community system F-1 Private Z"'Depth to Water Table 0 ft. Character of soil to a depth of 3 feet. Sand Gravel 0 Sandy Loam 0 Clay.Loam 0 Clay El Adobe 2--<rdpan ❑ Previous Application Made: Yes El No � New Construction: Yes 2"No 0 TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ion ---- Septic T nk- Distance from nearest well.57T----_7bistance from founclat --------------------------------------- ------ x---------- ut'6 iquid-dep*-W e------ Capacity,, No. of compartments....1-------------------Size-.!9�------------------- U? %�-. * V- 4x-4 Disposal 'eld: Distance from nearest -------Distance from foundation--_f.---_-- ...Distance to nearest lot 2-4 - ------------------------ ----------Width of trench-- Number of lines ---1)---------Length of each line--- Type of filter m------------ ri --------Total lengthJAR...................... aterial.....I,—X jl�-----Depth of filter mate 'al-./ - Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line----------------- 0 Number of pits---------- -----------Lining material------ ----------------Size: Diameter-----------------------Depth--------------------------------- Cesspool: epth--------------------------------- Cesspool: Distance from nearest well-----------------Distance from foundation --------------- - -Lining material_...____.-__-----_--_---._-_-_-_-__--. 11 Size: Diameter------------ -------------- ---------Dept h------------------------------- --------- ------Liquid Capacity----------------------------gals. Privy: Distance from nearest well------------------------------------------------ Distance from nearest building------------------------------------------ ElDistance to nearest lot-line----- ----------------------- ----r—---------------------------------- ------------------------------------------------ --------------------- Remodeling and/or repairing (describe)------------------------------ ----------------------•---------------------------I------------------------------------------------- --------------------------------- ---------------------------------------------- --------------------------------------------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------I ---------------------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------- ---- I hereby tify that I have prep ed this plication and that the work will be (lone in accordance with San Joaquin County ordinances, S ate Of the S n Joaquin Local Health District. (Signed)----------- ---------- - - ------ --- -- ------------ --------------------------- nfracforl f- By--------------------------- a By:----------------------------------------------------------------------------- - -------------------------- ------ ----------------1 Tif I. ------------------- in rel ion to , etc., can be plAced on reverse side). (Plot plan. showing size of lot, location of system Ww6fis, buildii, s. e FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY$- -------- --------- --------------------------------------------------------------------- DATEq!�p—--------------------------------------------------- ------------------ DATE---V'-------------------------------------------------- REVIEWED BY----------------------------- .. . .. .... .— ------ ---- -- - ------ -------- - f- BUILDING PERMIT ISSUED----------------------------- ---------- -------------------------- DATE-----7�- ------------------------------------------------ 9j\ Alterations and/or recommendations:------- ------------------ -- --------- ---------------------------------------------------------------------------------------------------- ------------------ --------------------------------------------------------------------------- ----------------------------------------------------------------------------- --------------------------------------------------------------- --------------------------- -----------:-----------------------------------------------------I -------------I---------------- --------------—-------------------------- -------------------------------------------------- ------------------------------------ ------------------------------------------- -------------------- ------ -------------------------------------------------------------- ----------------------------------------------------------------------- ------------------- ------- ----------- ---------------------------------- ------------------------- -------------------------------------------------------------------- FINAL INSPECTION BY:— ------ ------------ Date--- ----------- D---q---)------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, Californiania 3 Lodi, California Manteca, California Tracy. California E5-9-21A 145446 ATWCCD 1254