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------------------------- APPLICATION FOR SANITATION PERMIT / f,7(Comple#e in Duplicate} Perini# No. , l -Application is hereby made +o the°San Joaquip frois t He fres 1 Year From Date IssuedThis application is made in c Date Issued � ompllance with County alth District for a permit to construct and install the work herein descrbed. / ty.Ordinance No. 549,JOB ADDRESS AN LOCAT Owner's "•/s--• l- ._._ ___.•- ---- --------•---•------------------------------------- dress--•------•-•------ -- ------------ ------------ 7-_ ___ --- Ph Contractor's Name____." , s nstalla#ion will serve: --•---- ------- ---- ----"-`--- ti Residence � -------`-"-"--------�-- •-- ••--- Phone-----------------•------ ------ � Apartment House - - -'- I Number of livingunits: __f ❑4 Commercial ❑ Trailer Court-___ Number of bedrooms.-. ❑ Motel ❑ Other ❑ r Water Supply: Public' stem Number of baths __ . Lot size ._ � Character of soil to a `depth of 3❑fej to muriity system Private ----•- �pth to Water Table�. ft- •-•-•----•----•- Previous Application Made; llf yes;idatesand ❑ Gravel ❑ Sandy Loam ,. ❑ Clay Loam ❑ Clay dobe TYPE OF INSTALLATION AND SPEC1plCATIONS: l No ❑ New Construction: Yes E] Na ❑ ❑ rdNo ❑ (No septic fank�or cesspool permitted if public sewer is areileble within 20 ❑ F ANA• Yes ❑ 6 is Septic Tank: Distance from nearest wet!_-s'5T 0 feet.] [� Distance from foundation_ O - r No. of compartmenfs_____"- - .-._ ! Size__ x' Material._ f Disposal Field: --------------Size Liquid depth- ' Distance from nearest wellc Distance from foundation__ D ' •- --- ----.-'_Capacity-.-/do n r Number of lines._.--- "2 f_-.__Distance to nearest lot line___ S• , ----•------- --- ---------Length of each line --"�_� Type of filfer material--= _ !� -De Depth of frlter material_-- _ 7 Width of trench_,_ f-•% Seepage Pit: p ..__ _ Distance to nearest well_ Qd Distance fro fou dafion • � �"---------- -Total length_. - Number of pits-__-•- �s I nrr+3aDisfance to nearest lot lin.e--- ' Cesspool: �-�"- - --ening materiaf___ � n. -_�"Size: Diameter_____._ Of {ram nearest well----__ 3 --------.Dept h--------2:'s-�-� ❑. _ -- size:..Diameter------------- r�' Distance from foundation._.------_ v -i in Privy: Distance from neaest w - _ T D-vwepth ----------;_---------------- iquid Capecif , ------ _... . ❑ _ :_ . ..,_ _ .. -.<. tY ------------gals. = - Disfance from nearest buildin ~ Distance to nearest lot fine_"------- ------ — ,, --------------------------=------------ -- ---• -- Remodeling and/orrepairing (describe):__--- - ----- F ................................ --•-•--•-•-••-------------•---- ---------------------------______"____-"_ ----------------------------------------____________________________------ __________________________________------------ --------------_------------ _________________._____-______-___.______-___._____._----------------_--------------------------- ----------------------------------------------- T p - I ordinances, S+ate las, and rules and re at, sof the San Joa --------------------------------- I hereby certif;that I have prepared this a lication and that the work will be done in accordance with San J . quin Local Health District, oaquin'County 5 Signed)----------------------------- -- J r_ - -- ------------- -----"---------------------------------------- -------------------------------------------- --------------------------------------(Owner arid/or Contractor) (Plot ------------------------------------- Plot Plan- showingsize of lot, location c Owner and/or Contractor] y {Title)__-__---- v- f system.tn.relation to wells;;buildin s etc., can be laced on reverse side]. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY__"- J=VIEWED $Y ------------------------------- - -- DATE BUILDING PERMIT ISSUED---------- e --- (�r: ------- --------------------------------------- ATE---- -------•---------••--------•--------------------------- Alt rations and/or recommendations: _-- -- - -------------------------------------------------------I------------ -- -. --•�_---•----- `7 j3 -------------------------------------------------------- _ A`. ✓' -- _ - - -- ------ -- ----- ` --••------------------------ -----•--•---._. ------------------ " ------------ FINAL INSPECTION BY: ---------- ._" _, -•-------' r -- - -- ---------- Date-- --------------- SAN JOAQUIN LOCAL HE 130 South American Street 30HEALTH DISTRICT 6 + Stockton,California 0 West Oak Street 124 Sycamore Street E8-9 REVigEp 8.59 f.p,C p.RM 6-8p Locil,California manteca,California 205 West 9th Street Tracy,California {