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C APPLICATION FOR SANITATION PERMIT Permit No. (Complete m Duplicate) Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to con This application is made in compliance with County Ord' ante No. 549. strata and install the work herein described. JOB ADDRESS AND:LOCATION---------ATIZ ` Owner's Name-_-----_-- j " - ----- '-'--j �ortJ Address_.. LL ,r� ----- ---- ---------- --- f7a t t -------- �--- �--- .-. Phone-_. --- • Contractor's Name a /7 . �......=--------------------------------- I ,tR�r{�stj Z-2�--------- - Installation will serve: Rdsidence- -------- >--. Phone___ --•- ry Apartment House ❑ Commercial � pf--"-----' Number of livingunits: ❑ Trailer Court ❑ Motel ❑ Other ❑ �__ Number,of bedrooms _�_ Number of baths __ Water Supply: Publics stem of-- Lot size •- -„S' re f p Q----------------- Y , Community system ❑ Private ❑ Depth to Water Table _ aft. Character of soil to a depth of 3 feet: Sand ElGravel E] _._Sandy Loam ❑ da Loam ❑ NoX New Construction: Yes Y E] Clay ElAdobe Hardpan [] Previous Application Made: Yes TYPE OF INSTALLATION AND^SP ECIFICA' TIONS: ❑ No El (No septic tank or cesspool permitFed if public sewer is available wi SSWtic,Ta 4 thin 200 feet.] Distance from nearest well -_-Distance YT from foundatjon--------------------No. of compartments-•-- -- - ---.Material_---- �---- ------ ----- -------•----�---------- Disposal F elc}; Distance from nearest well- Size--------------------- Liqui depth--------------- _.--Capacity---------_____ �. S---Distance from foundation --- Number of lines-1_-1-----_ I ----.Distance to nearest lot Length of each line__-___'-_.___ p , Type or filter maferial._L:_ -----.Width of trench__ -5 `� _ ---__Depth._of`filfi�r�marial_-------- - -------------- Seepage Pit; -Distance to nearest well._fle7�r 10--------- -W Seepage' length.......... D tante f m foun ation__ ` ” ` wDistance o nearest lot line_____.. • 4 Number of pits-___s- /-,.- _ _Lining m feria �' Cesspool: ------ --Size: Diameter ply Depth ; p w Distance from nearest istance fro oundafion-------- Lining material --_____------__-_-- ❑ Size: Diameter____.------------------------- ------------------------------------------------- rivy: Distance from nearest well____---__-_......... Liquid Capacifiy--------------- -----------gals. Distance to nearest lot line- ---------------------------Distance from nearesi building '-------------- ----------------- Remodeling and/or repairing (describe):__---_-_--_-_ T T ----------------- r ------------- -------•----------------•-----------------------•---------•--------- --------------------- ----------------------------------------•--------- - I hereby c that I have prepared this application and that the work will be done in accordance with ordinances, Sta la s, and les an�gulat,ons of the San Joaquin Local Health District. San Joaquin County (Signed)------------ By:-------•--------------------- -------------------- -------- - -------------------------------------------------- - Contractor] on ctor] __ ------ (Title)-- (Plot plan, showing size of lot, location of system in rel ion to wells, build' s etc., can 6e placed on reverse side, 9 � } I FO DEP TMENT USE ONLY APPLICATION ACCEPTED BY------------- ------- ------- -='---------------------------------------------- -------- � DATE REVIEWED BY yf --- BUILDING PERMIT ISSUED----- ATE--------------- ---------- -------------------- ----------- Alterations and/or recommendations:------------•--------- - ------ ------------------------------------------------.-- DATE.----- -------------- ------------------------------------------- ------------- •------------------------- ---------- --------------•--•-------------•---- ---- -------------- ----------•-----------•---_ ---------------------- ---------------------------------------------------- ----------- ---------------------------- - - - -- - ------------------- ------------- FINAL INSPECTION BY:______... -- r 71 --------------------- - --------•--• ate---- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 Soufh American Street1 300 West Oak Street 132 Sycamore Street Stockton, California Lodi, California814 North "C" Sfreet Manteca, California Tracy. California ES-4-2M 10-52 Revised W-21o0