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ate! g �1Y y APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) hpplica ion is es my made to the Sara"Joaquin Local, tea th Di rict�for a permit to con ru pp made m com liance,6 iY _ ct and install the work herein described. p Couni"yfOrdrnance No. 549. - LOCATION--JOB ADDRESS AND • i --------------- -�•- --- -- -- ---- --- -------- ��7 -� ' -11 Owner's Name- ----- - ---------Address_..-------� ------------- Phone----------------------------_------- �.�1�-._.- _ -'C'-- -------•---------------- ----------------------------------- --------------- Contractor's Name---------------------------------- --•- - •------------------------ a - lam Installation will serve: Residence Phone -----------------___j-__--_.- �Apartment House 0—Commercial D.-Trailer: Court [] Motel ❑ . Other E]Number of living units: _ --- Number of bedrooms _ Water Supply: Public's stem 3 �.- Number of baths .,�__ Lot size _ / " PP Y� y ❑ Comm'un'ity system ❑, Private R-'-Depth to Water Table _/ ft. Character of soil to a depth of 3 feet: Sand gavel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe[] Hardpan E]Previous Application Made: Yes El � New Construction: Yes El No [ FHA/VA: Yes ❑ 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---cP_�_'Distance from foundation-- 1l) Materials---�-C' U.A!��---------- ©'— No. of compartments -a--------------Size--4_��c.�6-.'.-------Liquid depth----<�1� - --- ----Capacity-•---: �-d--` Disposal Field: Distance from nearest welf_�d � .� - ©f Distance from foundation---a�_�-_-6__2 stance to nearest to line- 0 1- Number of lines----------- ------- Length of each line `d _F Type of filter material-.•Sl_ - -0_G-- of filter materi r Width of trench._- - --- Depth Yp _ t a� y�ftlength- Seepage �.+.�°leif� --Total length- = — SeepagePit. Distance to nearest well ' ------_Distance from foundation--------------- �- line Number ----.Distance to nearest loft line-_-------------- 'f --------Depth--------- ----- y Dumber of pifs----------------------Lining material-----------------------Size: Diameter-----____-- Cess Cesspool: 7 5 ' ---------------•- P 1 Distance from nearest well---------------- Distance from foundation_-------__--------_.Lining material--------.----------------------------- ------------------------------------------------- _ ❑ Size: Diameter-------------- ------------- --------De -------•- ---------------=--------Liquid Capacity- gals. Privy: l z A Distance from nearest well----- ___--_.__ -----------------_-------- Distance from nearest building ' ❑ , Distance to nearest lot line--- -------- -------- -- -------- --------•---•---------------� ---------- ------------------ -- Remodeling and/or repairing (describe):--------------------------------------------------------- --------------------------- t, r F I hereby certify that I have prepay d this application and that the work will be done in accordance with San Joaquin County , ordinances, Staid`aws, and rules an "re ulations offithe San Joa4in Local Health District. (Signed) ---------- �� ll (Owner and/or Contractor) By---------------------•- Title (Plot plan, showing size of lot, location of system in rel tion to wells, buildings, etc., canbe ------------------------ on reverse side-- FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY � � REVIEWED BY----------------- - DATE----------- ----67----•-- BUILDING PERMIT ISSUED_-- ----- - ) --"---------- DATE-_- ------------------------------------ - - -- --- ----------------------------------------- - ----- ----------------- DATE---------------------Alterations and/or recommendations:-----_.___f_--------- - -•----- FINAL INSPECTION BY:--- -- 7Z,� --------------- Date----- � ----------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 Wes} Oak Street 132 Sycamore $tree} Stockton, California 814 North "C" Street Lodi, California Manteca, California Tracy, California ES--9-2M , Revisea 1-57 ERCO.