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nN, APPLICATION FOR SANITATION PERMIT Permit No. _`��-�'._3 1 , ------- ' (Complete in Duplicate) . , , Date Issued .S--r_3 f__�-J � • Applica+ion is hereby made to the San Joaquin Local Health District for a permiLio construct a install the work ein d scribe This application is made in complia-06ce�with County Ordinance N 5 KVV 4.�-tsE.� %4, P , —JOB-ADDRESS-AND"LOCATION_- - Owner's Namei --- -. Phone. Address--------------------- �d --- -- - -- - - - - Contractor's Name . -----.. Phone-------------------- -- --------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: --/-- Number of bedrooms -5.. Number of baths .&- Lot size ' ------------------ Water-Supply: Public system ❑ Community system ❑ Private (] -b7epfh to Water Table -z: ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam 9-_�- C`lay Loam ❑ Clay E] Adobe 0 Hardpan ❑ Previous Application Made: Yes ❑] No ' [ New Construction: 'Yes'E�—No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: r (No septic tank or cesspool permitted'if pe se sewer is available within 200 feet.) t - Septic Tank: Distance from nearest we _4:�'4 __Distan_a rom- -foundation----�� •---.Myat �er-ia-El------��, No. of compartments----- -----------------Size- -__ Liquid depth---f-- Capacity--- / - - �-A-�-^- - -�-�-�----. ` Disposal Field: Distance from .- ell.. nearest -.--___Distance from foundanon-_ r� t�---....Distance to nearest to Zine_--�--------- Number of lines--------- [--- ---------- ength of each line------ _------------ Width of trench..__ ---------- Type of filter material- .� � E th of filter material_._.- r -------- potal length-------1-4pe-•------------------- to ❑ t well _ ----------------•--_-Distance from foundation to nearest lot line------------------ tI Seepage Pit: Distance o pnearesNumber -- ----Lining material---------- ------------Size: Diameter_ "---------- --------Depth--------- ---------------------- I Cesspool: Distance from nearest well----------------- _ -.--_--Distance from foundation-------------------- material-------------I--- ---__--- - ❑ Size: Diameter 1--------------------------------- Depth Liquid CapacitY---------------------------gals, Privy: Distance from nearest well------------------_--------_---_---___.__.___-_Distance from nearest building------------------------------------------ El Distance to nearest lof-kne----------------- - ------- - ---------- ---------------------- t:� -g / repairing ( be):----- emo ein an o� rE airin descri ----------------------------------------------------------- --------•----------------------------------------•-•---------------....------•----••--------------------•--•-------•----------------------------- ----- --- at I ave ared this done ordinances, State laws,and,rules arnd regulations olfGthe San Joaquin the Local Health eDistrctn accordance with San Joaquin County ��__ - (signed)----••--------- ---- --- ---' --r---- - .wt's By:------•----------------------•---------- I rContractor) -- -( = -= (Tit siTe). FOR plan, showing size of lot, Iota of system in relation to wells, buildings, etc., can be placed on reverse ss' e). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-�---------- ECA REVIEWED BY � - --------------------------------------------------------- DAT -,.� -•--------------------------•--------------- ----- ---------------------------- ----------------- ------------------------ --- ------ DATE_-Q1' --------------------------------------------------- BUILDING PERMIT ISSUED -- - -------------------- --------------------------------------- -------------------.. DATE........ -------•----------- Alterations and/or recommendations:------------------ - ------ - --•----•--•-•- ------------•-------------------------•----------------•-•------ -- -----.------ ------- ----- ------------------------------------------ ------------------••-- -------..------------------------ FINAL INSPECTION ------------------------------------- t SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American $treat 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California I x ES-9-2M 145446 ATWOOO 12-54