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APPLICATION. FOR SANITATION PERMIT Permit No. LI/ a (Complete in Duplicate), ""--•• Application is hereby made to the San Joaquin Local Healt trio for Date Issued � �•�5`A71- This application.is-made in corn fiance wyth County Ordi a permit to construct and insfa'I�he work herein described. ,r�2+(r. : .. f 6-f-Ecv�f_�� f 1 4 o. 549. JOB ADDRESS A L C " Owner's ---- ��A •"--- ress_. --- -- -- ------- Phone L v - Contractor's Name--- --------- --•-------1--------------- ' Installation will serve: Residence �' ❑-- --------------------- " --------------=-=--- Phone------ --------- Apartment House Commercial Number of living units: __" ""- Number of bedrooms ❑ Trailer Court ❑ Motel ❑ Other ❑ Water Supply: Public System ��- Number of baths " PP y� Lot size ------------------ --------------------------------------------- Character -- ___ Y ❑ Community system ❑ Private "-"�-�--"---�--- -""-�- ---"---�--- Character of soil to a depth of 3 feet: Sand Wr Depth to Water Table-30 ff. P ❑ Gravel ❑ Sandy Loam A Clay Loam Previous Application Made: Yes y E] Clay El Adobe❑ Hardpan 0❑ f No New Construction: Yes No ❑ TYPE OE—MALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest w-el _ _ '� 1/ Dista c� from founjation___ No. of compartments___ SiZ� y O { Material.._""_"-_---._ r • /�- �- Liquid d pth �' -" -- Disposal Field; Distance from nearest well . r Capacity'__.lU __Distance from foundati n__ -:" Number of lines___-_____ .Distance to nearest lot ne" • --- Length of each line---- -10�Ll__ Type of filter material_ �j-ri W+ th of trench . { �i- --- -" - _Depth of filter mafierial__-- ""- $- -._____--_Total length--/�-0 Seepage Pit: Distance to nearest well------------------- --Distance from foundation________._ _ ❑ Number of Pits--------------------- Distance to nearest lot fine----------------- Lining material___--_-.----"" -_-..Size: Diameter--------------- Cesspool: Distance from nearest well-----•""_--- Depth__.-------.........." El Distance from foundation "_"-_ "-" Sizc: Diameter----------------------------- ------------ Lining material----------------------- ----- ----- ----------- eptly--------------------------- ..... ---== -•=- --- +w Liquid Capacify-_.-"_"-" Privy:' Distance from n a est well" ._-"_" - gats. Distance from nearest buildin �. . El Distance to nearest lot fine_____________________ _ ------- emodeling and/or repairing (describe):_----""- --•---•------------------•---•----------------•---------- ------ ------------ ------------ --------------------------------------eti . • p --aie ------ -----------------------------•--------------------•-- ------------•---------------------------•- I hereby certify that l have prepared this application and that the work will be done in accordance with San Joaquin ordinances, State laws, nd r d regulation of th San Joaquin Local Health District. q County (Signed)-------. ---- By-------------------------------------------------- f (Owner and/or Contractor) (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can(b'el placed o-- reverse side), ) - -------------------- FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY _-"""_"" REVIEWED BY �� — . DATE �� i h - ------ BUILDING PERMIT ISSUED---- - DATE---- --------------------- __________ Alterations and/or recommendations:""--."-""---- " ------------- ------------------------------------------ DATEFIN ----------------------------- - -------------------------/-- ---- -- �`-� AL INSPECTION Y:_ ___. •� -------------•-- ------------- Date _ -- ---------------•---- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street Stockton, California 132 Sycamore Street Lodi, California 814 North "C" Street Manteca, California Tracy, California ES-9-2M 10-52 Revised W-2100