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, --'' APPLICATION FOR SANITATION PERMIT Permit'No. t! U I f. ell (Complete in Duplicaf ) Date Issued _------Applicati iee ` a o fh`e San J&2qu in Local Health Districtiior a pel ilit tll coOr and install t This applicatiori is made in compliance with ounty Ordinance No. 519. /n he work herein described. I04 JOB ADDRESS ANDD ATI [ -- - - -----------?VWVJW77�---(A7 , A;4 � Owner's Name----------- / -------- - ---------- -- Phone--------------------------•-------- Y.104014- ----- l Contractor's Name---------------- -- ---------------------------- ----------------------------------- Phone. Installation will serve: Residence Apartment House [❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ fE Number of living units: _- ._- Number of bedrooms j__ Number of baths - ` Lot size ifs ------------------------ Water Supply: Public system ❑ Community system �rivate ❑ Depth to Water Tables ft. Character of soil to a depth of 3 feet: Sand ElGravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Applicafion Made: Yes ❑ No New Construction: Yeso �!lV ❑ FHA/VA: Yes ®�No E] `* TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or`cesspool permitted if public sewer is available within 200 feet.) i Septic Tank: Distance from rkparest well - �___Distance, rom foundation-_-_ -- �g `l l �J� � � �y a —AAP-----Materriial----Com' Q No. of compartments----- a -----------Size_; ---_�.--'-- ® Liquid depth-:�------- ---------Capacity--��---- isposa Field: Distance from nearest well__--""._Distance from foundation------ - j 1�- -_-.--Distance to nearest lot line___ _---_- ' Number of lines---_--- -_-_. Length of each line_-- +�- <! y -------------Width of trench-----4- -- Type of filter material__ y1. - s�d4epth of filter material----14 ----Total length------ -_�__---_-_- ------------ i" Seepage it: Distance to nearest ell-- _ _-_-_Distance f m fo dation___ I A Number ��.------.D" t fce to nearest to line__-�------- ------------- � Dumber of pits--__-O" Lining material-- .Size: Diameter-_. ____---- p 3 _ - " ' De to-- - Cesspool: Distance from nearest well_----__._------Distance from foundation--------------------Lining material-_____--__------___---------_------- r ` ❑ Size: Diameter------------------------- ------------Depth----------------------------------------------------Liquid Capacity-.-;----------------------gals. g - I Privy: Distance from nearest well------------------------------------------------- from nearest building ❑ Distance to nearest lot line----------------------------------------------- ----------------- ---- �f©�A = Remodeling and/or repairing (describe):--------- -------------------------------------------------- --------------------------------------------------------•--------------•----------------•----------•- ------------------------------------------------------------------------------------------ ------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County if ordinances, State laws, and r les and regulations of the San Joaquin Local Health,District. k'i (Signed) -€ - ---------- - --- - - --- --- - - ---- -----------`------------- - ------=-------------- -------- r Contractor] BY� --- ------------•- ------ Title ------( � )--- (Plot plan, showing size of lot, lova ' of system in relation to wells, buildings, etc., can be placed on reverse side).- FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------- DATE_---T--__ a= -------------------- _- BY-------------------------------------------------------------------------------------- ---------------------------------- - DATE------------- -- BUILDING PERMIT ISSUED---------------- ---------------------- - DATE ------------------------------------------ Alterations and/or recommendati ns------------------_.---__---.___- ---------------------------------------------------------•------ s--------_i_RR a- ----- - ------------------------ - - -- ---------- -------------------------LL-- --------- ------- ------- ------iv__17A----- FINAL INSP --- ----- - ----- Date------ '"' SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California Yt. E5-9-21x1 Revisea 7.37 F.P.CO.