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VVIDOZ (� APPLICATION FOR SANITATION PERMIT Permit No. _ � + (Complete in Duplicate) 3/ Date Issued __,..! �.. 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 withCountyOrdinance No. 549. JOB ADDRESS AN LOC ION --- " ` �� C �, c i Owner's Na ----•-• Phone.._.... . AddressZ. --- iL:� .Z_. v' ---•-•--- --------- ------ • ---•-•• ------------................................................. Contractor's Name............... ...-•----•-----•-- ---------------- ................................................................................ Phone......... Installation will serve: Residence X Apartment House ❑ Commercial I] Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _/.__ Number of bedrooms-.1. Number of baths ._._ . Lot size ......_54 XJ........................ ...._ Water Supply: Public system ❑ Community system) 1 'Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam❑ Clay Loam❑ Clayjy Adobe❑ Hardpan❑ Previous Application Made: Yes ❑ No K New Construction: Yes �r No ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public seller is available within 200 feet.) Septic Tank: Distance from nearest well/O.4". Distance r•om foundatj9e.._.l_0.......Ma erial No. of compartments--------!�,r______.__Size__..!x" _� .� Liquid depth....... .. p y._ .... Disp saI Field: Distance from nearest well r 6 A d Distance from foundation _..�. Q ..._.Distance o est lot II erg .; Number of lines-_--•_-_I-- ___•.__.Length of each line_..,ZQ".�b�. &idth of trench . Type of filter material__..$.7.1%tdll of filter material.------- 4R.._.Total length...........ill ............... Seepage Pit: Distance to nearest well---_------------------Distance from foundation.._..._ ....Distance to nearest lot line ❑ Number of pits......................Lining material-_--------_---------Size: Diameter.__:... Depth.__............._.... ......... (V Cesspool:' Distance from nearest well... from foundation--------------.._.Lining material...................................... ❑ Size: Diameter--------------------------------------Depth--- ------ -- ----- ------Liquid Capacity ------------_-----------gals. Privy: Distance from nearest well ----------- ------------------------------ Distance from nearest building..... .......:: . "~ ❑ Distance to nearest lot line---------------------------------------------------------................. ......................................... ...... .............. Remode ing�andr repairing (describe)::- - --- ,.--. --- --- -- � ------------- ------------ - ------------------Y------ " ----- --- ------- ------ ....�� " --- '-��r�+ y` I hereby certify that I v repared this applica ion and that the work will a done in accorda ce woa yth Sara!Jg4C:0 n ordinances, St Taws, an ides gulatio of the San Joaquin Local Health District. -+ (Signed) •----•- •-- (Owner "" er) "V $y•••--••---------- ----------••---••••-- --------.---------........ ------.................................................. -- ------ ------ --•--- ..---•----(Tiifle).. .----• -----•-- . .------- (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.............................................. REVIEWED BY---------------------------------------------------------------------- '." --- DATE , , BUILDING PERMIT ISSUED -------------- w DATE Alterations and/or recommendations -----.................... --------------•-----------.....---•-•........ .•••--••........_..._...•---.---- ......... ---------------- a %� . " Y ea4 9& r FINAL INSPECTION BY:- -----. . " to--- �Q `7L ...._ .. .................... 4 130 South American Street 300 West Oak Street 132 Sycamore Street N " Stockton, California Lodi, California Manteca, California Tracy, California E5-9-2M ; Reviseci 1.57 F.RCO.