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APPLICATION FOR SANITATION PERMIT Permit Nlo. -- -------- 1 �3 (Complete in Duplicate) Date Issued4_ ----.0�_----63------ I� Application 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 Ordinance No. 549. f� t --------------•----------- i' 1 ------ - --•- JOB ADDRESS AND LOCATION------ ------- ---- Phone.------------------------- Owner s Name------ ��'i ------------------- ------------ --------------------------- _,.1Address 't= - ----------- Phone--- . - - -------- Contractor's Name------- Other ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Installation will serve: Residence ❑ p Number of living units----------- Number of bedrooms .------- Number of baths --------- Lot size 4____-- --_r_p_a _--_ Water Supply: Public system E�.Community system ❑ Private ❑ Depth to Water Table ________ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel El Sandy Loam [I Clay Loam ❑ Clay E] Adobe❑ Hardpan ❑ ' previous Application Made: Yes ❑ No "'New Construction: Yes ❑ No �- - TYPE OF INSTALLATION AND SPECIFICATIONS: i 0 feet.) (No septic tank or cesspool permitted'if public sewer is-available within 20 1 __.Material---------------I------------------- --------- ---� Septic Tank: Distance from nearest.well_--- ---___Distance from f oundation_________________ Capacity - Li Liquid de th------------------------ ----------------------- t ' - - - q P. No. of compartments-- --------- on ------- Size :r Disposal Field: Distance from nearest well____------------__Distance from foundation____-_____--___-__.Distance to neareist lot line.-_________-___.. en ------ Lth of each line------------------------------Width of trench-''--------------------------------- i Number of lines------------------------- g + Type of filter material--------------------- ---Depth of filter material-----------------------Total length--------Ii--------------------------------- Type ------ -------- ----: -------- �� I st lot line__.jn' ----- Seepage Distance froth foundation____-,?-�.-�----.Distance to Weare Seepage Pit- ` µ Distande to nearest well_ -- Size: Diameter__--_4' -".---Depth ��--1--------------- � Number of pits.------/-------------Lining material_ f .._ .-�. ing Cesspool: Distance from nearest well_________________Distance from foundation- _------ `Linuid Cateac"t gal r ❑ Size: Diameter_="_---- -- ------- p --------------------------Distance from nearest building-------i---------------------- ------ --- Privy: Distance from nearest vrell--------------------- M_-___-______•--------------_-- -- • Distance to nearest lot ine_____-__-._------------- -- - II Remodeling and/or repairing (descr'sbe)------------------------- ! -. -------------------------- ------------------- - - ;I --------- ------------------------------------------------- - pP - - -- -o u- I hereby certify that I haveprepared this a licat-o that ha Joaquin he work will Local Health be do rict.In accordance with'iSan Joaquin County 1 ordinances, State laws, and rules and regulations of heSan 9 Qwwet.anel f er�Contractor) {Signed) (Title) -/J� _ ----- -. $Y= ---- ------------- ------------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---- -------------------------- ------------- DATE --- ---- - ---------------- -- -------------------------------- -- DATE REVIEWEDBY-------�------------------------------------- ----- ----------- DATE-----------------------M-------------------- ------------ BUILDING PERMIT ISSUED--------------•----------------------------------------=---- -- r. '" ------------------- ---------------•-------- Alterations and/or recommendations-------------•------- ---•----------`�-------------------------- -------------------------------- ------------------------------ - ----- .; --------------- ---- Date Vii"°'---- ------------ 10110f - INSPECTION BY--------------------------- SAN - ----- - I SAN JOAQUIN LOCAL HEALTH DISTRICT r 132 Sycamore Street 81411 North "C" Strae 13o South American S+reef 300 West Oak Street T�raey, California. Stockton, California t., Lodi, California Manteca, California ES-9-2M 10-52 Revised W-2100 -