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APPLICATION FOR SANITATION PERMIT Permit No. -- --- \� (Complete in Duplicafe T� S_ ..uJ�,'U Sp;r4-t/E Date Issued . Applicatio ereby made to the San Joaquin Local Health District for a permit fio construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. !s7 ©�T�� / ed. JOB ADDRESS AND LOCATIONr Owner's Na -------------- ,r ------------------ Address-- ------------ - Phone 4146 --- - ----- ------------ Contractor's Name--------------•-_-___ Apartment 9--;',6 o� 1 Installation will serve: Residence -•--------------------------------- Phone.__Aartt House ❑ C immercial ❑ Trailer Court ❑ Motel A ❑ Other Number of living units: -__ Number of bedrooms I Water Supply:- Publics stem umber of baths ._ c_- Lot size Pp Y� y Community s stem f Character of soil to a depth of 3 feet: Sand ❑ Y Gravel ❑PrlSand Loam to Water Table-�ft. Previous Application Made: Yes No Y ❑ Clay Loam ❑ Clay ❑ Adobe,® Hardpan [] l ❑ New Construction: Yes Z No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well-AIkAd Distance from foundation_-.1Q Sd No. of compartments._.. _ ------..M terial--- ,� ---------Size_,"?'C„16,11 v Liquid depth - ------------- isposal Field: Distance from nearest well_14Qy�---Distance � fd��n �� - Capacity. 4-42P. :,�. ® Number of lines--- ines__ 1- --------Distance to nearest lot line_-off j Length of each line--- _ Type of filter materiai__-1_ +f Width of trench..-,l// -�- 1-- __Depth of filter material------1-'%---Total length------Vo__© � _.; Seepage Pi}: Distance to nearest well_ - - C�_-_ _Distance fr XI�lumber of its. WTf �istance to nearest lot line-__.-w�---_-_1 p ----__-__--___Lining mater _Size: Diameter__ .- !! jo Cesspool: __.-.___.Depth_.-- - � ❑p Distance from nearest well ________Distance from foundation--.--_--_-__ Y Size: Diameter------ - -Lining;material.__ ,f --- - ------ - -------Depth------------- ----------------------- .r.Priv - rda aci ` " I p __ Y� Distance from neaiest well----------------- '�' r - - ----------- --------- a s. #awe om Distance to nearest lot line____ nearest buildin g----- ------------- ------------ ------------------- Remodeling and/or 'repairing (describe):--------------:-_-_-__ I � - ,.--------------------------------------------- f ----------------•------------- ---•---•--•----------------------•-------- ------------ - I I hereb cerfif that l have prepared this application and that the work will be done in accordance with San Joaquin Count -------------------•------------------------------------------------------------ a ----------•------- _________ ----------------------- or ordinances, t e aw and rules an regulations of fh San Joaquin Local Health District, Y r (Signed)_______ - ------- ----- Y:-------------------- Contract {Title) (Plot plan, showing size of lot, location of system in relaf n to wells, buildings, fc.. can be aced on reverse side). Contractor) ) I= R l7EPgRTMENT USE ONLY APP LIGATION ACCEPTED BY -------------------- -------------------- ----------------------------- ---• DATE-----/ - REVIEWED BY---------------------------- r - ---- BUILDING PERMIT ISSUED-------•------ .f ATE -------------------------------- ------------------ ----------------------- Alterations and/or recommendations:.. DATE ------------------- - - --------- --------------- ----------------•------------------- ------------------ ------------------------ ---------------------- -----------------------•-- ` / ---------- INAL INSPECTION 8Y---------------------__-_- -----------•--- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street Stockton, California 132 Sycamore Street 814 North "C" Lodi, California Manteca, California Street Tracy, California E5-9-2M 10.52 Revised W-2100 f