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i Permit No. __._ - T_ - __ 3--- ,,APPLICATION FOR SANITATION ._�.tMl7 (Complete in'Duplicatel Date Issued ---1I or �PerNo const �t and�tall the work here-n described. Applica;ion is hereby made to the San Joaquin Local Health District f , This a li ation is ma in compli with County rdinance No. 549. yxZ C� �P J B ADDRESS A LOCATIO/)"C7�� '� r Phone. t-------------- .1_. .. -------------------------------- Owner s Name_-- --------- - - -- ----- -- --- - ••--•-------•---------•----------- -------••-----------------•-----------•- Address---------- _ -.. Phone - Contractor's Name----- ---•--------------------------- Other � Installation will serve: Residence Apartment House ❑ Commercial E3 Trailer Court El Motel ❑ � �t 1._ �:;�------------------•- Number of living units. .------- Number of bedrooms -___--- Number of baths ____..._ Lot size ______ _ ` Water Supply: Public system ❑ Community system ❑ Private 9 Depth to Water Table ft. Character of soil to a depth of 3 feet: Sand ❑ Gravelo Sandy Loam Clay Loam ❑ Clay Adobe❑ Pardpan_❑ New Construction-. [jYNo Previous Application Made: Yes El No 1� ,t TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) , --.Materi I -------- . Sep is Tank: Distance from nearest well-,. Dista ce fr f un ation__.___�. I Capacity1 -�-- No. of compartments_....�-------------Size_�__X_7r0_- --•-Liquid depth----- ---- Disposal Field. Distance from nearest ,,ell.- .._---__. .Distance from foundationDistance to nearest lot line------------------ ❑ Number of lines-------------------- -------------Length of each line-----------------------------.Width of trench------------------------- --------- Type of filter material---_-------------------.-Depth of filter material- .-_.--.--_____Total length----,------._____------------------------- Seepage Pit: Distance to nearest well.'_____..- __----Distance from foundation____________________Qistance to nearest lot line-.-________._.-._ El -------------- Lining material Size: Qiameter-----------------------Deptjh----------- --------------------- Number of pits------- Distance from foundation_-._ ..__.___.__..Lining material_______________________.__-__-.____.. Cesspool: Distance from nearest weV1-----------------� _- ------------ epth D ___---- ------ _ .Liquid d_Capazity� Size: Diameter- ❑ .r �_ — - . - -- --- Privy: Distance from nearest well._.'___ ___ ____ ____ ______ .---------. Distance from nearest building. ____-. _.._ ------------- ❑ - --------------------- -----•--------------------- Distance to nearest lot ine__--------------------�--- �-------- ----- L �` • Remodeling a d/or epairing (describe :_...- -�.__-.__ l ' --ct.1---- - en- r I -- -- j /� �-� --�- �- � �' I hereby certify that I have prepared this application and that the work wiN be done in accordance with San doequin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. --------------------- ------------------(Owner and/or Contractor) F ------------------------------------------ --• -- -- -•----- ------- --- =�=- --------------------- --- --- - ---------------buil-dings-,__ -----------(Title-------------------------------------- ------------------------- (Plot ---------- ------ -- (Plot plan, owing size of lot, location of system in relation to wells, etc., can be placed on reverse side). � FOR DEPARTMENT USE ONLY f� _ DATE--------------------- `�� -------------------- APPLICATION ACCEPTED BY------------ --------- ---------- DATE jj k REVIEWED BY ----------------------------------------- BUILDING PERMIT ISSUED------------------------------ DATE - ._.. - -------------------------•---------------•---•---------- Alterations and/or recommendations--------------- . - ---•--- --------- = --- ---- -------------------- - - - ------- ----------- -- ------• -- FINAL INSPECTION BY:..-___-.--'=---- ----- ----------- •------ -------- Date-- . --T f l ------�--- --------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 300 West Oak Street 132 Sycamore Street 814 North "C' Street 130 South American Street TracCalifornia Stockton, California Lodi,'California Manteca, California ri E9-.9-yM 145x46 ATS ...