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„✓`'f APPLICATION FOR SANITATION PERMIT Permit No (Complete in Duplicate) F - •-- Date issued -__%/ --5 Application is hereby made to the San Joaquin Local Health District for a This application is made in compliance with County Ordinance No. 549, permit to construct and install the work herein described. JOB ADDRESS AND LOCATION-__- �rd = �r Owners Name----- ---------•----------------------9.4 -----•- - ------ s4Rl'1i _ Address.. ---- ----------------- Phone------ Contractor's Name-------- •---------------••----------- ----- ,0 --------------- Installs#ion will serve: Residence ----------- Phone-----��” _f Apartment House ❑ Commercial ❑ Trailer Court Number of living units: _.-I__ Number of bedrooms _ ❑ Motel ❑ O}her ❑ Water Supply: Public system �-�--- Number of baths - ,� - Lot size ��AP- �Q �- Y ❑ Community system ❑ Private Depth to Water Table ___-____ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sand Loam Previous Application Made: Yes No ; Y ❑ Clay Loam ❑ Clay ❑ Adobe jg� Hardpan ❑ ❑ New Construction: Yes D5,No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well Distance f om foundation___- No. of compartments_2-------------- 'L Q-------.Material--- _ a __Size " _ X- /� e. - Liquid depth. " Ca acit I iir_ Q-�jA \ Disposal Field: Distance from nee es# weft- 'C �3 �$N p f.�----._D+starce from foundation__1_C)`� j""`stclo- t line Number o�i iines � - / - -- ---Distance to nearest lot _______._/�� til -_Length of each line___R7_SJ_ -_- �._ Width of trench._ �• Type of filter material--I __Depth of filter material__-/�- Total length 4 � Seepage Pit: ---- 7 Distance to nearest well ---Depth from foundation______-- r ❑ Number of pits____________________ -----------Distance to nearest lot line_-___.._------_-_ -Lining material-----------------------Size: Diameter------•--_-.-- Cess ---------- Cesspool: --------.Depth------------- --•---- ❑P Distance from nearest well--------------- -Distance from foundation--------------------Lining material---------_------_----_ Size: Diameter------- - -- -- --------------Depth----------- - --------------- - - - -- -----Liquid Capacity-- --------- Privy: Disfance from nearest well----- - --------gals. _Distance from nearest buildin ❑ Distance to nearest lot line-------------------------- - g-- ------�------- _-- ----------- emo eling and/or repairing (describe):__-________________ - __ ------------------ I herebyf i thatI have preparLea., plication and #hat +he work will be done in accordance with San Joaquin Countordinances, 5la s, and ruI and rof +he a Joaquin Local Health District. Y (Signed}. Y: - --------------7j� on#rac# Title- r 0 ------- (Plot plan, showing size ion of sys min rela+io wells, building etc., can be placed on reverse side). ( } X34 FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY________________ __ 1:--- -- - ----- -------------------------------------------- REVIEWED BY------------------------------- DATE-------_--J-- t� UILDING PERMIT ISSUED ----------------- ---- . DATE- ---- ------- - ------------------ ---------------- BAlt DATE.------------------------------- --------------------------------- and/or recommendations----------------__-_ -----------"-------- FINAL INSPECTION BY:.._ 001 "o ------ Date_. -if.."�=`� 3 --------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street Stockton, California 132 Sycamore Street 814 North "G" Street Lodi, California Manteca, California Tracy, California ES-9-2M 10-52 Revised W-2100