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� Permit Na. ___r<I1_a'---'�-_7.__ { APPLICATION FOR SANITATION PERMIT _S ' (Complete in Duplicate) Date Issued __�---- - -------- l ep d install the work hereidescribed. San Joaquin Local Health District for a permit to construct an Application is hereby m �l ad• t� the Sa This application is made in compliance with.-County Ordinance No. 54 . - JOB ADDRESS AND O. C kON___ _- ---�- --�----- ----------- ----------------=--------------------------------------- t _ - --------------------------------------- Phane ------------ ----------- Owner's Name---, ; . - ----------------------•---------------- �� Address- -- --•- Phone. ---=---r - Other Contractor's Name----------------- Trailer Court ❑ Motel ❑. ❑ j I� � artment House ❑ Commercial ❑ Installation will serve: esidence AP v� tot size __- � p- '�---------------------- 1 Number of living units: -/-- Number of bedrooms _-o - Number of baths _a" ��ft Private ❑ Depth to Water Table - ardpan Water Supply: Public system Community system ❑ Clay Loam ❑ Clay ❑ Adobe ❑ +, Gravel Sandy Loam ❑ Y Character of soil to a depth of 3 feet: Sand ❑ ❑ FHA/VA: Yes 9?---No ❑ i` No. New Construction: Yes �o ❑ Previous Application Made: Yes ❑. 1. TYPE OF INSTALLATION AND SPECIFICATIONS: 1 sewer is available within 200 feet.) {No septic tank or'cesspool permitted if pu I' Distance from foundation- `p--=---- Material_---- Cepa r ,/ a Septic Tank: ;Distance from nlearest well-____r._. _ depth____,-------------- Capacity-_ No. of compartments---. - size__ �-- _-4-/-'Liquid - r d,' �------ --_Distance to nearest lot line___-•--- ,� .. > �i 4 Disposal Field: Distance from nearest well_---._ Distance from foundatign4 , Length of each line_---��pp------ = -----------Width of f Number of lines---_--- G ----- -- g �• �' `--._-De th of filter material_---- �- -------Total length------ --- ►Q- Type of filter material__/,,&;0�`' p l Rj i Distance fr foundation_. 0- __.D sta`ce to nearest lol Imw_�--------- De Depth Seepage Pit: Distance to nearest well Size: Diameter- - '" P Number of pits-_-- -----------Lining material--- ---- ,-, � 11 • Distance from nearest well_______---_-,-.-Distance from foundation---------------=---Lining materia__--_-----!--------------'---------- Cesspool' -------- . Cesspool: Liquid Capacity I gals. l ❑ „ , Size: Diameter-------------------------: De. - 1 --�.: a II ----------------- . - Distance from nearest building._______-.____-_--_---- Distance from nearest well ------------------------------- ------------ ------------ Privy: ------------------------ ---- -_----•-=-----------=------------- I : ❑ Distance to nearest lot line__----- -- �^ - «. --------------------------- ------------------- A t. Remodeling and/or repairing—(de cribe)=------------- �`ti"`" -------- -- 11 I � 4 I - ------- :i .f _____________________________________________________________________ ________________________________________________________________ _______ I hereby certify that�l have prepared this application and that the work will be done in accordance with San Joaquin County I ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. -- Contract (Si ---- 9ned) - By: buildings, etc., can be place on reverse si [Plot plan, showing size of lot, locat' of system in relation to wells, t FOR DEPARTMENT USE ONLY �I ------ -- , ------------------------- DATE APPLICATION ACCEPTED BY--------------------------- DATE------- - --- ----�-- ------------------------------------------------ a REVIEWEDBY-------------=--- ---'---- ------------------- DATE-------------------------- ------------------------------ ------------------------------------------------------ - BUILDING PERMIT ISSUED — --•----------------- --------------- -------------- Alterations --- Alter ions nd/ r r mmendations:_`=----- ..:___----- ='.__,r " === = r ---•---- --------- --- - ---_ - -- ---------- G. ------- J ---- ----- ------------ [ �+n^ -- �_ -------- -- --- ------ - �- - / ate--- --- _ � � ------------ INAL I SP TI :.. � r ,� U1 OC ALTH Dl RICT SAN Q I l32 Sycamore Street 814 North "C" Street 300 West Oak Street Tracyi California 130 South American Street Lodi, California Manteca, California Stockton, California Revised 1-57 E=,P GO s `l.