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/ C APPLICATION FOR SANITATION PERMIT Permit (Complete in Duplicate) Date Issued /_!/•`J 7" -7T d. Applica+ion is hereby made to the San-Joaquin Local Health District for permit to construct and install the�rk In r in ascribe im This application is .made'in compliance with County Ordinance No. 549 ��41��a „ A f)') 1919 ------ ------------------------- Phone 'UA101 O--—04------------------- V'------ � $ c. JOB ADDRESS AND LOCATION_ `- S phone----- Owner's Name_�h-4-cam- - �.. Address"_t?. r!`# Phone" Installation will serve: -Reside Contractor`s Name----------------- -------- --- -- -----"""- nce $ Apartment House,❑ Commercial ❑_ Trailer 'Co_rt Motel ❑ —Other Number of living units: ""�__ Number of bedrooms --'1' -__ Number of baths " Lot size _ ._ - --- Communit s stem ❑ "'PrivateK Depth to Water Table Water Supply:Supply: Public system F1Y Y , Clay Loam ❑ Clay [I Adobe Character of soil to a depth of 3 feet: Sand E] Gravel F-1SandyLoam ❑ Hardpan �. Previous Application Made: Yes No ❑ New Construction: Yes +No ❑ s TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tankor cesspool permitted if public sewer is available within 200 fees Aor ---------.Material---- W' Septic Tank: Distance from nearest weILQO""-_--;Distant from foundation."�" it ,�/ �"wn_ " .Li uid de th-f --- Capacity_ No. of compartments_-r----------------- -Size -*�----- q p•4 Disposal Field: Distance from nearest well------- ---------'Distance from foundation---__--------------Distance to nearest lot line------- Number of lines----------------------------------Length of each line ..Width of trench. Type of filter material------ ------------ -Depfh of filter material----------------------- length-----------------------------"-4 1 - - Distance fr m foundation-" --_.--.Distance to nearest=line---� T Seepage Pit: Distance to near e tiwell_.,�_ _.-- --__ --Linin material- -- - Size: Diameter _r1-3-----------Depth_ 0.1 pag of p�fs--T--------------- g material-AW-4-- Distance from nearest well from foundation--------------------.Lining material_-__----._-_-_____--_.---______-_-_-. _ — g ;� - R. . �.�Size• Diameter---------------------- -- "_---------.-- — _ �iquid Capacity. -•"-_.. 1 Priv D stance from nearest well----------------}------------- - --- ---- -----Distance from nearest building----------------------,---- Y ' . ».� -------------------------------- ---------------------------- E] -------------------- -- ----- - -- -------------------------------------------- ----------- ------ ---------------------- i a, ��' otl __ �� e,r. .." ---.C9 -e.& .eat. ... Remodeling and/ repair ng describe:_." __ _ ------ �1 11rLiC �= IC �!� �Q.�'`.f�L -7------i�f" � -- ------------� jole 4-10 n S t'� I hereby certify that I havee Prepared this application-and the San Joaquin Local Health Districtn accordance with San Joaq44 uin County R ardanan ; _- .. Contractor) (Signed}--- -�"I�_Iia-t-5- ----- ��-- -------- ------- - BY:---•----------•--------•----------•----------•------------- ----- -------------(Title]_ _i�►.�_� Q - (Plot plan, showing size.of.lot, location of syst in relation'to wells, ildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY DATE------- _ - — APPLICATION ACCEPTED BY----- _. ..�, --_—.,.- DATE_---- ------ --------- ••---------------------------- --- I REVIEWED.BY----------------------------:----------- ------ BUILDING PERMIT ISSUED--------------------- -------------------------------------------------------------- DATE------------------------------------------------------------- -•---------•---------------------------------------•- ----------------- Alterations and/or recommendations----------------------------------------------------------------------------- = ---------------------------------------------- ------------ - ----- - - .. FINAL INSPECTION-'BY:--------- -------- -•------------=-----= --•--- ------•----- Date--------- v/---" '--------- -------- --- -:•----- SAN JOAQUIN LOCAL HEALTH DISTRICT 1n 5 camore Street 814 North "C'Street 130 South American Street 300 West Oak 5t:eafi Y Trac California Stockton, California Lodi, California Manteca, California Y. t