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I APPLICATION FOR SANITATION PERMIT Permit No. ./d_l__---71. (Complete in Duplicate) Date Issued ___ �lf/__�j 2-12—! Application is hereby made toIthe San Joaquin Local Health District for a permit to constfuct and install the work herein described. This application is mace in compliance w' h County Ordinance N 549.lip ��Q/J� &wcol JOB ADDRESS AN TI'ON., -- - --------�7---- -Owner's Na --- - -- --- -- Phone------------------------------------ ------ --- --- ----------------------------------------------------------------------- Address-- ---- --------------- --------------------------- Contractor's Name------ r ----- -----------------------------------------------------------------------------------•----- ---------------- Phone------------------------•---------- Installation will serve: Resiclenlce Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _L..__ Number of bedrooms _Number of baths I____ Lot size _1--4ft �13.�'-P..�_______________-________�.k I� i Water Supply: .Pubkic system ;h❑ Community system ❑ Private Depth to Water Table . 1 ` Character of soil to a depth of,3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan [ Previous Application Made: Yes ❑ No New Construction: Yes No E] FHA/VA: Yes El No El 1I TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) i Septic Tank: Distance from nearest well_16_64--Distance fro founds • n__ __ _______.Mat it,______ ____ __________________ _. ( ei f �/ Liquid de th______ ,_ __ pacity______ No. of co apartments_---_ � ^^___-____--S�x _._f_� -X_ . r !� Disposal Field: Distance from nearest well-�Q V_+_Distance from foundation____,!✓_-______Distance to nearest lot lin Number of: lines____ ___ ___________ ength of each line__-- __ rWidth of trench_____��'_ _� ____ Type of filter material____ epth of filter material___-__ ____ , Total length- Seepage en g f th___-_ Seepage Pit: Distance to� nearest well-----------------------Distance from foundation--------------------Distance to nearest lot line----------------- ❑ Number ofjpits----------------------Lining material-----------:-----------Size: Diameter------------------------Depth-------------------------------- Cesspool: Distance fi-Iom nearest well-----------------Distance from foundation--------------------Lining material------------------------------------ - ❑ Size: Diameter Depth ---------------------------------------------- Liquid Capacity ------9a1 Privy: Distance from nearest well--------------------------------------------------Distance from nearest builcllng------------------------------------------ El Distance to nearest lot gql��ine � - ---------------- Remodeling and/-or repairing (describe):_d'F'--__- �_;:---___� ____rJ_____'___-________+'"�' - +� ----- ----------- •-•-----•------------ 7---------------- ---- -----i`-----•----•-------------------------------------------- -----------------------------------------------------------------•------------------------------------------------ ! he by certify that I have prepared this application and that the work will be done in accordance .with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed) d -----� - f" ( /or Contractor ___Owner and ) T - —-- __Title Plot Ian, showing size of lot, -------------- --- - --------------------------------------------------------- ------------------------------------•--------------------------- --; [ p g location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---- ---------------------------------------------------------------- DATE------ �� rr REVIEWED BY------------------------------------- ------- --•-------------------- DATE BUILDING PERMIT ISSUED ------------------------------------------>----- -,-------------`-- DATE --- --- - r - i ations:Alterations and/or recom end ------------ ----- •----•- a it -------------- - - c --- ..c,e.., - 4 --- q FINAL INSPECTION BY:------- _ Date-------------_------------------------------ I SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South Amsrican Street I 300 West Oak Strest 132 Sycamore Street 814 North "C" Sfreef Stockton, California li Lodi, California Manteca, California Tracy, California I E5•--9--2M Revised 1-57 F.P.co. II