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APPLICATION FOR SANITATION PERMIT Permit No. _---_��..... _ r (Complete in Duplicate) IIIssued __ . _ Date .75_ Applicakion is hereby made to tTh San Joaquin Local H a1th District for a permit to construct and install t work herein described. This plication is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATIOi.___----- __ --- __._ - , Owner's Name `'cx�tl------- Phone ------------- Address - - ---------------- / Contractor's Name____________ ____ iy /yp -=------------------------------- ----- •-------------------- Phone' d ,3--- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑�j Other ❑ Number of living units: _N----- Number of bedrooms -- = Number of baths ___{____ Lot size '_ ---------------------------------- Water Supply: Public system ❑ Community system ❑ Private [v-*"Depth to Water Table 441 ft. Character of soil to a depth of 3 feet: Sand U Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑ No 2 New Construction: Yes i?rNo,❑ TYPE OF INSTALLATION AND SPECIFICATIONS: ' (No septic tank or cesspool permitted if public sewer is available within.200 feet.) �€ =- -.'SepticTank': Distance—from -nea'rest--weH--._ T - ance from foanda#s�n_ -Mate _________�-_."._'._�_ .�____"__�_. No. of compartments--..._.-_.--_-_�_ �Size - Liquid de th_- - Capacity---------------------- a, Dspad: Distance from nearest well--- ---.-- _Distance from foundation_s-----------Distance to neaprest lot line______--____- De th of filter material_._. . _._.._._.._Total length____,: Number of lines------------� t�� -Length of each line-------- �� -----------------•--- "?V . Type of filter material---L .LICf? .- p Width of S Ir - Seepa - Pit: Distance to nearest well...�_�O�_._______Distance fro foundation__._j_4____.___. istance to nearest lot li�ne�----_ [ number of pits. ---I ------------- g _De �fn Linin mater}aL_! r $ize: Diameter 2--- - p 4 Lining l --"----------- 4 r� n Cesspool: Size: Diameter.nearest well --------------- -- -----Depthce-from foundafiion--------- ---- Liqud_Capacity---------------------------- als. Pricy: Distance rom nearest well ... _____________ ____ _____________Distance from nearest building_.__:____.__._____.__________...____._._. ❑ Distance to nearest lot line-------------------------------------------- " -----------------------------------------------------IN---- ------ / p g wd __ • � R odelin and or re iri (descri L�"� �_ t.___.. ...!F----- R ^""-,It G _ -----------------••----•--.-------------------------•--------------••-•----•-----.-----------------•--•----------------------------------------.---------------------------------------- -------------------------------- Ni ,4 ---------------------------•--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance withL , San Joaquin County - ordinances State laws, and rules and regulations of the San Joaquin Local Health District. ! (Signed �� Sewner and/or Contractor) By------------------- ��Id - {rile) - - �, . _ , Plot Ian, showing size f lot, location of.s stem.in relation to wells,.buildin s, etc.,,can be laced on 10 FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY `�,,� ` -------- ------ DATE------ --- '". ' REVIEWED BY----------------- ----- ---- - f ------------------ DATE--- --� --- ._...-------- BUILDINGPERMIT ISSUED----••--- •------------------ --------------------------- --------------------------------- DATE---------------------- •--------------------- Alterations and/or recommendations:------------------ -- ------- ----------- ----------------•------------------ ----------•--------_------------------------------�------ ....... ------------------•--•------------------ --•----•----------- ................ ------------------------------------------------------------------------------••------------------------------•------------ FINAL INSPECTION BY:. �; ------------------ Date_._../YI -f__ .. M SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Stre \ 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California '•\ Manteca, California Tracy, California , Es--g 145446 n-rwoao ,