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Q _ APPLICATION FOR SANITATION PtttN at No. ---- _ _I. --•--- `1' (-5 (�� i (Complete in Duplicate) Date Issued -_- 1(11*47 Application is hereby made to the San Joaquin Local Health District for a permit to construct end install th m rk h This application is made in compliance with County Ordinance No. 549. M Fat" JOB ADDRESS AND IjJCATION . 5 - -- yy� "' Owner's Name ------- ✓`! phone---- e ......................... `. ............................ ....t-......_.. Address------------------ ..- Q/YIneC/-. - Contractor's Name----------- *N" ................................__---------------- Phone...... ............v..:------- Installation will serve: Residence* Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel 0 Other Number of living units. -------- Number of bedrooms -------- Number of baths ....... Lot size -- --------------------- -------------- --- Water Supply: Public system Community system C] Private [I Depth Depth to Water Tablaft. Adobe Hardpan s Character of soil 4o a depth of 3 feet: Send ❑ Gravel❑ Sandy Loam p`-Clay Loam © Gley ❑ ❑ Q Previous Application Made: Yes ❑ No ❑ New Construction: Yes 0 No ❑ F9Aj/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS. (No septic tank or cesspool permitted if public sewer is available within`200 feet.) Septic Tank: Di{tante from nearest wellS .._-Distance fro'{�Ciund t)on IQ-- Materi. " ' Nd. of compartments.._ .-_.Size .J�X.7 a�s -Llgwd depth _ __ .Capacity,�C � r* Disp I Fiesid: Ditance from neares ell ,_,Distance from foundation- Distance to nearest lot hn .. _ .... Number of lines - Lenglh ofeach line____ yy (rr i� Width of tre trench of filter matenaL._.I�Lt�2r!.-Depth of filter material _.. Total length ..__� f.- Seepag Tri}' Distant um er of pits Liningmaterial ! uiamere -- t rest well -..._. Distance from fou _ foundation -- material.._ Cesspool: Distance from nea _ F1 Size: Diameter. _. ---------- ----.Depth------- ----- - ------------Liquid Capacity... .....-------- :..gals. A Privy: Dittance from nearest well _ .._..--_ .__.._Distance from nearest building------------------ ❑ Distance to nearest`-lot line =- -- Remodeling and/or repairing (describe):_ -- - ------} ------ .- - ...... -- - ------------------ - - __: :_ .._ .. --- ._. .- . .... ... . . . : .... _ I herebycertify46at I have prepared this application and f e vir +VIII be-done 4n accordance with San Joaquin County \ ordmbnces, /t/g/1l-aws, and rules and regulations of the San J: Local H ial{l District. \ (Signed)._: —T _ (Owner and/or Contractor) C (Title) - ------------------------ - - r - (Plot plan, showing size of loft, location of system in relation to wells{ buildings, etc., can be placed on revei'seddlo) FOR DEPARTM" USE ONLY DATE __ q APPLICATION ACCEPTED BY... l V REVIEWED BY -. a --- BATE .... t o DATE . -- BUILDING PERMIT ISSUED. Aiterafio s an d/gr recommedatioos ._ _. -- �,r -. --- - - 1 8...✓..-J . .. _. . ... ------------ .......... -----_----------------- ---- _ .-- ._ .. .. ---------------- ' .._--------------------f _ ------ - FINAL INSPECTION BY. .. : ---- Date ._ �� _ Q _.t_. __ ____ SAN JOA QUIN LOCAL HEALTH DISTRICT 130 South American Street Soo West Oak Street 132 Sycamore Street $14 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M Revisea 1-57 E.P.CO.