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1_., APPLICATION FOR SANITATION PERMIT rmit No. (Complete in Duplicate) Date Issued Application is hereby made to the Son Joaquin Local_ alth District for a permit +o construct and install the work herein described This application is made in compliance with County Ordi ante 549. JOB ADDRESS AND LOC -------- -- ----- Owner's Address ----------------------- -----•---- ------- hone--., �p r► — --------------- ---d- . Contractor's Name_____ __-- -------------------•----------------------------- ----- L�6'110,2 p ❑ Installation will serve: Residence � -- - - ---•--- --- ---------- Phone--------------------------- ` A Apartment House Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _�-- Number of bedrooms _ Number of baths _ Lot size -------- x __----` Q Water Supply: Public system Pp Y' Y Community system ❑ -�--� --x ��----- -------------- vate Wafer Character of soil to a depth of 3 feet: Sand ElGraveI ❑PrlSand�oaDme❑h tGay Loamable _y4{}- Cl Previous Application Made: Yes El El Adobe, Hardpan E]❑ No � New Construction: Yes ' No E]TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 fee}.) Septic Tank: Distance from nearest well___-000 Distance from foundation_____ I No. of compartments .-_---- G '�Iy r ® Material ------_ p c --- ------Size- - -- -O' Liquid depth- Z��- Disposal Field: Distance from nearest weil_ QQ_�_Distance from foundation___- A Capacity- __._..Distance to nearest lot line___ f -r�. Number o7 lines--------------1 -------Length of each line-_-------r_�S'-- ___ W Type of filter material__3r_ �erC- Depth of filter material-___� _"_ Width of trench-_----- S--------------------------- �/ Seepage Pit: Distance to nearest well..� Q- Distance rom foundation__-- Total length_._- � " ---------------- ��-�----..Distance to nearest lot line - -� Number of p,ts_______-/-_------_-Lining material__ _.Size: Diameter___-3_4.."_1---- E Depth �---- — _S_ �i Cesspool: Distance from nearest well __ Distance from foundation-------------------- Size: Diameter-----�--- ------ -------- -- ------Depth Lining material--- ------------ ------------------- -Depth---- ---- _ Liquid Capacity----------------------------gals. ---- Privy: Distance from nearest well ....................... ----------Distance from nearest building---- ------------------------------------ --------------------•- emodeling and/or repairing (describe]___________________ ---------------------- -•- ----- ------------------------------------------------ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin Count ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed)------- •---- Y --------- (Ow er and/or Contractor) (Plot plan, showing size of lot, location sys#e lation t Ti#le__. A o wells ( ) "�` " '�- buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---- ---------- ------- REVIEWED BY------------------------------------------ ----- -- ---- --------------- ._ : ----------------------------------- DATE BUILDING PERMIT ISSUED___.---_•_----•----- r -- -{ -- ------ -------•--------------------. DATE------------- - ---------------- -77 ---------------------- --------- aerations and/or recommendations:- ----=--------------- ------------------- --------•---- DATE------------------ -- ------------------- - ----•--------------•------------ - ----------------------- ----------------- •------- - -- ------- ----- - FINAL INSPECTION BY-------------- - - �-� Date 'n 130 South American Street ------------------------ SAN JOAQUIN LOCAL HEALTH DISTRICT � 300 West Oak Street 132 Sycamore Street Stockton, California Lodi. California 814 North "c" Street E5-9-2M 10-52 Revised W-2100 y Manteca, California Tracy. California `