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JQ�jJJ/�, APPLICATION FOR SANITATION PERMIT � . ,Petmit No. .L._Yl..�-•/------ /��/- (Complete in Duplicate) ' Date issued ___________ _____ Application is hereby Imade 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 Count Ordinance No 549.. JOB ADDRESS AND C TION r-- ----- r 1. ^_. • --- ---- ----- .. .. _ + .. Phone -------- Owner s Name.- �. 4 . . . Address-----•--------------- w �. ---------------•---- ------------ -- e s Phon --- Contractor's Name----------------_ Installation will serve: Residence Apartment House ❑ Commercial [I Trailer Court:,[] Mo#el ❑ Other ❑ Of . Number of baths _7-! Lot size- �-- 1 --•----- Number of living units: __l..- hlumber,`of bedrooms _ T t Water Su I Public'system ,L+>Z ommun,t s stem Private ❑"' Depth'to Wader Table _�� ft. PPy- Y . Y ❑ ;. Character of soil to a depth of 3 feet:. Sand ❑ Gravel ❑ Sa.ndy,Loam ❑�'Clay Loam ❑ Clay ❑ Adobe ardpan ❑ 4r i VA: Yes ❑ No ❑ Previous Application Made: Yes E] No New Construction: Yes . o ❑ FHA I, TYPE OF INSTALLATION AND SPECIFICATIONS: , �iiable within 200 feet.)No se tic tank or'cesspool permitted if public sewer is av Mateno f7j- Septic Tank: Distance from nearest welV__ . Distance from foundation__ I- "Size_ �. - /----Liquid dep.h--- -- C ut --- �� No. of compartments___ Ri �-- ' ,stance from foundation_-__14P---------Distance to nearest I t line___r .___.._._ Disposal Field: Distance from nearest well_/. z '- // Width of trench ---- --;----------------- Number of lines--_---/---------------------- erigth of each line--_eaf ---------�r-- / Type of filter materiaL` Epth of filter material_--_. --------Tota4 length_ ----------- .. ---------- . •� _ .. � _ D.' to ce to nearee# lot line___�� - iy ,y+� / Seepage Pit: Distance to nearest well ----- lista ce-f om_ ou: -atian___ Depth__.__ 4u- Linin ma rial_�b - Diameter___ s _ _ Number of pits.._,/--------------- g i : r14 Cesspool: . Distance from nearest well________________D,s -ftsCindation.__._.___.__ -_____.Lining material-------------------------------- i -.---:-D. --=------------------------: ------Liquid Capacity---------------------------"gals- x Size: D,ameter.___y_:----------------, building❑ '"" °' a ' _--___--_4---__-Distance from nearest u, ,n G Privy: Distance from nearest well �.o _..^...... .�+. ----------- - ------------------------------------- : .�- -.: ---------------------- ❑ -—Distance pistance to ,nearest lot line_�__"------------------ , ----------------------•---- Remodeling and/or repairing (describe]:____----- - ( 7 --- --------------------- ---------------------- ----- ---- ------ ------- ------------------------------------------- - l - } -------•----------------------------- ---------------------,, = ".--------------•----•----------------------=--------•------------------• --------------------------------- ----------------------- --------- l ----=-- ------------------------------- - t e San'Joaquin --------------------_------ ---- ------------ ------------------------------------ ---------- �. --------- -- ---- � - I hereby certify that l-have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws,ad , and regulation of h 'Joaquin Local Health District. ! # �. . ------- -- ---- -----------.- ----- rContractor) -- ------ (Signed)--------------------- . - -_ . .x -(Title)---`/�.- P € (Plot plan, showing size of lot;locat10 system in relati�o� to�wells, buildings, etc., can be laced on rev si e. -• :FOR DEPARTMENT USE ONLY,. DATE------V---------------------------------------------- r -- ------- 1 s APPLICATION ACCEPTED BY_______ _______________ 'h � REVIEWED BY------------------------------------------ ------------- ------------= ---------------- -- - - •---------- DATE --- --------------------------- BUILDING PERMIT ISSUED------------------=-= - - -- r i Alterations and/or recommendations:--------------- --- --- ' ' --- = - ---- J i : ---------------------------------------- T ----------------- --- __- - --------- -- - - • ----- ---------------------------------------- ----------- ------------------------- ---------- ---�------ --.----------_ -------------------------------------- ---------------------- , �" Dat---------- e ------------------------•---------- FINAL INSPECTION BY._-_----,--- _-- `=----- --�" - SAN JOAQUIN LOCAL HEALTH DISTRICT 132 S camore Street 814 North "C" Streit 130 South American Street 300 West Oak Street y Stockton, California Lodi, California Manteca, California Tracy, California Revisea 1.57 F.i'.CO.