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APPLICATION FOR SANITATION PERMIT Permit Nv. ......73Jk (Complete in Duplicate) Date Issued ____ /�� 01�4d the San Joaquin Local Health District for a permit to construct and install the work herein described. Applica+ion is hereby made to 9 This application is made in compliance with CounOrdinance�No. S49. I �} f�/} --- - -------------- ---------------------------- ---- ------------------------------------ ADDRESS A LOCATION.-- ----V--- ---- --------- Owner's Name =-------------- Address ' -----------------•-------------------------- ---------------------------- ---- --._. Phone------------------------------ - ------ --I� ------ Address.-------•• --- ,----------• ------ --•-------•- -------------------------- Contractor's Name____ ----------------I- - - -"""""--"""-- I Commercial Trailer Court ❑ Motel ❑ Other ❑ Installation will serve: Residence Apartment House ❑ ❑ DAX /; / %3-. Number of baths ___ ___ Lot size --------------------- - Number of living units: _.�._- Number of bedrooms __ _ Water Supply: Public system Community system ❑ Private I� Depth t Water Table __.____ ft. Grave! Sandy Lo�rNo m Clay Loam ❑ Clay ❑ Adobe�ardpan ❑ � Character of soil to a depth of 3 feet: Sand ❑ ❑ Previous Application Made: Yes ❑ No d New Construction: Yes ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted ifublic sewer is available within 200 feet. P /} JDistanceX from ------- -Matei�L__ __------------------ Septiank: Distance from nearest well .-__"_ aci -- —a-- ------ No. of compartments--------- Liquid depth_"_____ � " Cap = c' Size `..___._Distance from found ton J.0 istance to nearest to lin __CJ Dispos ' Field: Distance from nearest well_-_._._. ,y� jr""" 4' !� Length of each lineL A o3S. `'-.Al Width of trench__________---------I_____.____._ " Number of lines__________ ___ _ 9 fl 'C.� De th of filter material--_.-----�- � ----Total len th----------"- ".-13-- -------•--------- Type of filter materi _ " U— p g r = -- --------- Seepage Pit: Distance to nearest well----------------------Distance from foundation______._ _____.__..Distance t-- nearest lot line__-____________- ❑ Number of pits-------------------_Lining material------ --------------- Size: Diameter Depth ti. Cesspool:'" Distance from nearest well________________"Distance from foundation----- material------------------------------------ Li uid Capacity gals. ❑ Size: Diameter-- ------------------------------ --- Depth 9 p Y Privy: Distance from nearest well--.-_-- ---------.-Distance from nearest building------------------------------------------ , - ----• ---------- ---•----- --------- -- Distance to nearest of Fne._------------------------------ -•------------ - ----------------- - Remo e g an or repai ing describe):------- --- - ----- -- �� "f`� �------------------ ---- ----- �� ----------------------------------------------------------- -----------*------------------------------- -v---N ------------�---- - ------------------ ------------------------------------------------------------------------ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. ----------------- ---------------------- ------------------------------------------(Owner and/or Contractor) Si ned _ _1�� - -------` { 9 ) Title ----------- ---------------------------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY ' DATEQP ----------------------------------------- APPLICATION ACCEPTED BY - DATE_Z--- --------------------•-------------"•---•-------- REVIEWED BY------------------------------- --------- ------ -------------------------------------------- - BUILDINGPERMIT ISSUED"-----•--------------------------------------- --------------------------------------------._- ------ DATE------q 7 :Alte4+Van /or r commendations:.:.___-- --'- ------- V---------------- --- -------.___ --- ---- - �°� ' - - - - -- - _ FINAL INSPECTION BY---- -------- --= =. Date...7 SAN Q J" OA UIN LOCAL HEALTH DISTRICT 300 West Oak Street 132 Sycamore Street 814 North "C" Stroe+ 130 South American Street Trac California Stockton, California Lodi, California Manteca, California y. ES--9-2M 145446 ATWVdD lz-sa