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APPLICATION FOR SANITATION PERMIT Permit No. _- ?67 0 (Complete in Duplicate) Da Issued fie l d -_`----Application is hereby made�to-the San Joaquin Local Health District for a permit to tonstrucf and install the work herein described. This application is made in aompliance`with County Ordinance No. 549. JOB ADDRESS A LOCATION.. �, ----4.uo*j ---- 1 -_- --- , w -- -------------- --- oPhone Owner's Name # -----------•--R- -----Address Cantractor's Name- -------- Phone. ----- E- 1Installation will serve: Resident 'Apartment Ho se Commercial C] Trailer Court ❑ Mot I .;.:.,a. ; M + ❑ Other ❑ g : ------__°Number of bedrooms ----I--- Number of.baths --_[_:_- Lot size um er o living units Water Supply: Public. system'❑' 'community system ❑' Private"[Depth to'W.afer Table --�p f#. Character of soil to a depth of 3 feet: Sand '❑ Gravel ❑ Sandy Loam❑ . Clay Loam :11 y ❑ Clay p Adobe Hardpan ❑ Previous Application Made: PLl es ❑ No New Construction: Yes No ❑ FHA/VA: Yes ❑ No 1 TYPE OF INSTALLATION AND SPECIFICATIONS: y (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) Sept Tank: Distance:from nearest'.we4__ _�.LDis}an e fr foun tion_--_- aerial---- ---------------- - ji� c _---•- No. of compartments_--"__--- _.T Size__4�_ Liquid depth_-. 1_5L/ Ca acifi �6 ] - p y-A-70 --------- p - �isfance from foundation_---�. - Distance }o nearest lot line_-- _ / �------_, Dis oral Field: Distance from nearest well--_; -- __ + Type u of fillter maters _ Length of each 'line____-!4 a-- --_� --_--.Width of,trench- _--- ,- � _ p g4 material----•r-Ls_---- ----Total length--- ---+n------------••-•-•-- Distance from foundation See a e Pit: Distance to nearest well--'_-.'-`--" Depth o7'6ier _____________ Distance to nearest lot line--:..�-_._-----_ ❑ Number of pits = Lining material :. ..--..Size: Diameter----•----=------------ Depth-------------•--------`- Cesspool: Distance from nearest well---------------`-Distance from foundation----:__------_ ----•Lining material------,--_------------------- El - - Size: Diameter-------"---- -,- - ----- D�pth Li Liquid,Capacity air � -------------------------------------------- q J _ P Y ----- - - 9a[s. Privy: Distance from nearest well----1--- -- }----------------- t ; -_-._..-Distance from nearest building--------------------- -. a Distance to nearest-lot line--------------u - i• i___ - -• ,Remodeling and/or repairing(describe):----_..:---_---._---__ � - _ ----------------------•------------------------ t - r . ------------- •--------•--------------- = _---------------------------- - -------- ----••-------•----- -------- , --------------------------- -•---•----- -- ---------------------•=---------------- ----- ----------------------•----=-----=---••------------------------------------------------------------4, ;I hereb certif that I haveY y prepared this application and fhat the work will be done in accordance with San Joaquin Count ordinances, State laws, and rules and r_egula}ions of the San Joaquin Local Health District. (Signed--- Y ) - ---------------- - ----------- ----- (Owner and/or Contractor) y ---------, --- • - -----•--=--------------------- - ------------4Tifle)------------------------------------------------- (Plot plan, showing size of lotlocationIof system in relation to wells, buildings, etc:, can be placed on reverse.side). FOR DEPARTMENT USE ONLY f APPLICATION ACCEPTED BY------------------------------------------------ --------------- -: ----- -- ----- --------------- DATE REVIEWED BY-------------------------- --------- - - DATE -._�:-�e_. -- ------- BUILDING PERMIT ISSUED,-=--•�••----------------------- - - � - - ------------------ --------- DATE. Alterations and/or recommendations---------- Ii. ------------�---__----_--."-. - ------------- -•--------•._._•--•--••--- -----•---•---•------------------------------ ----- FINAL / INSPECTION BY:------- Date - -- - ----------------- ------------------------------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 Wast Oak Street 132 Sycamore Street 914 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M Revisea 7.57 F•P M li