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(APPLICATION FOR SANITATION PERMIT Permit No. --..--••---- [Complete in Duplicate] Date Issued .----- lica4ion is hereby made to the San Joaquin Local Health Districtfor or.a permit to construct and install the work herein described. Thisapplication is made in compliance with County Ordinance No. F.. 7- _111 ------------- ---------------------------------------- JOB ADDRESSAND LQCATION.- phone..�fl� r�"�. .• = -- -------Owners Name------•--- --•---•---•------•---------•--•---- Address__..._.._ -------- Phone --------------•------------ ---------- Contractor s Name------------- - Other artment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ 0 , Installation will serve: Residence �Ap - Lot size ...x :,�1� Number of living units: _�_-_-- Number of bedrooms�._ Number of -------- baths _ r I Public system CommunitY s stem ❑ Private ❑ Dep4h to Water Table �ft. Water Supply:y• Y Character of soil to a depth of 3 feet: Sand 171 Gravel El Sandy Loam ElClay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes F1 No [I 'New Construction: Yes,[:] Nom TYPE OF INSTALLATION AND SPECIFICATIONS: septic tank or cesspool permitted if public sewer is availabVe within 200 feet.) f 4 T k: Distance from nearest Weil.). Distanceff iom fpundation_. - -Capacft ��41 '` No. of compartments_... -----Size al - •---Liquid depth--- ``� f-� le----_._-.-Distance to nearest lot li fi _1--- f" -_. - -- .Distance from-foundation___ :�. - Di osal isld: Distance from nearest wefl.� '- r Number of lines--- ---``-:�-------------Length of each line----- r .-_ _. ,-...Width of trenchf ----• r ` Type of filter material-- f��F, `Depth of filter materiai_._..� -__�---Total length ----' ------------ I f__ ---- c Distance fr .m fou�ation___-��- stance to nearest lot � Distance to nearest well_._�� r --_ C' at: � %----size: Diameter rt Depth pi Linin materia tfiO Number of pi+s------- ------------- g l Cesspool: Distance from nearest-well_____________ __Distance from foundation_.._._.._...-..-__.Lining material------------------------------------- Depth ---------------------.Liquid Capacity----------------------------gals. ❑ Size: Diameter................. --------'------- p ---------- ------ ---------------- --- --------Distance from nearest building--------- ` Privy: Distance from nearest well___.._ .- --.------- ❑ Distance to nearest lot line.:-. ---------------- r f r ----- Remodeling an /or• r pairing [d-- - ; ):___.- � a-- �1' '- -----------" -------------- � -- ---------------------- ------------------------------------------- -- h - ----qui -- -- I hereby certify that 1 have prepared this application and that the Werk will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the Scan Joaquin Local Health District. f f zxl.----------- (Signed) L_1 '+ [i ----------=--------------------- -4.( �CiOntraGtOr� Si ned --------- { g }-..._..___ �' ,� � _[Title]-r _._._ /�'�� --�-��-.`fir_________________________ ��' - BY:----•----- - f�l pp (Plot plan, showing size of , location of system in relation to wells, buildings, etc., can be placed on revers Ide]. FOR DEPARTMENT USE ONLY ------------------ DATE:, --------- ----------------------------------------- APPLICATION ACCEPTED BY. DATE---t, ------------------------------------------------ REVIEWED BY - s D E.-----.q -� BUILDING PERMIT ISSUED.------- !.:—,I ------------ - --- ---------------------------------------------------- - Alterations and/or recommendations:____ -----_-__. .. ------- [��---------- --------•--------- / '�. Ql ------------ ----------------------- ------- ------------ -- ----- - k -------- ------------•-- -- ---------------------- ------- -------------- f Z -f��" ------------------------------- ------------- Date.-.. _..- FINAL INSPECTION BY: -- --.- --'-- 4 + e*- l SAN JOAQUIN LOCAL HEALTH DISTRICT - � 132 Sycamore Street 814 North "C" Street 130 South American Street 300 West Oak Street TracyCalifornia Stockton,'California Lodi, California Manteca, California Y' h c5_y 145446 ATWDOD voF