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APPLICATION FOR SANITATION PERMIT rFo Permit No. �: C ` (Complete ----- / Date Issued Application is hereby made to the San Joaquin Local Health District for a per to construct � ��1�a -4 This application is made in compli n �R County Ordinance No. 549, and install the work herein described. JOB ADDRESS AND L CATI ---- Owner's - Owner s Name = 'r ---------•---•- { - •- y - ---- ------------ neAddressPhone 14,�A-- -- ------------------------------- ----------------- -----------------•--- Contractor's Name___ _- p,o ,-� Installation will serve: Residence r re-- Phone__ __ - _,.__ � ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other Number of living units: --------!Number of bedrooms ____-___ Number of baths ____-___ Lot size ------------------ --- - Water Su I Publics stem PP Y� Y ❑ Communit s stem � -•--•-------------- ----------- Y Y ❑ Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Cla ;Loam Previous Application Made: Yes ❑ No NY ❑ Clay [] Adobe ❑ Hardpan ❑ ❑ New Construction: Yes [] No ❑ FHA/VA: Yes ❑ No ❑ 311 � TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) Distanc Se Tank: e from nearest well___� stanca from u dation__.___ ..�� Mrial_ __ No. of compartments_-'------ --------__Size____-�-__ �j - �-• - -�• -- _ -_ Liquid depth------------ Disposal Field; Distance from nearest w ll -__ -"-Capacity_-- ----._.Distance from foundation_ Q_,._.__Distance to nearest lot line_- �Q pdi Number of lines_____________ Len th of each line-.3.&_g = © r�. b'; f trench._---- z- ��--_____..___ Type of filter material__-_ f' -- - Depth of filter material-___._-_1-_ Seepage Pit: Distance t earest SF -------- c f m {�undation-- 5�i►otal length______,_ --Q_-_ ------ ------------------ ----- Number of pits..___-_- Dis ante to nearest lot fine'__- --- . . .�-------_____Lining materiai___ �.-Size: Diameter____ 09 Cesspool:p Distance from nearest well___--•------_----Distance from fou j -.Depth__.._____._ ---------- ndatio� -- -,_...Linin material------------------ - C �. El Size: Diameter-----=---------------------- - ,�. �, -------- Depth-------------------------------------- Privy: -- _ _ ,� ... �.... ..,, --- --- Liquid Capacity_. -- r Distance from nearest well----------- ----- --- "r �" » , r.� ______--_______Distance from nearest bu•rlding.-__---.-_- ❑ -Distance fo nearesf lot line_.._---__- --_- " ---- -----------------------=------------------------------- ------- Remode' g an /or repairing (describe):_____ !tel - - _ �, ,. ------•------------V-------------------------- ------------ `�----- In •rt! _ I hereby certify the} I hav repared this application and that the work will-be-do ------- - ----ordinances, State laws, and rules and regulations done in accordance wit gu ations of the S n Joaquin Local Health District. "W. h San J - Si ned _ - 4 un y Joaquin um- o } w y `` ------------------- --(Owner and/or Contractor (Plat plan, showing size of lot, location of sstem in relation tow (Title)--------•--v--------- ------------- - F r ells,,buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY _ APPLICATION ACCEPTED BY------------- - ----_---- REVIEWED BY = DATE BUILDING PERMIT ISSUED---=------•-------------------------- --------------------------------------------------------•-------. DATE and/or recommendations:----------•-- f_ ----- DATE - ------------ t ---------- ------------------ --------------------------• ----------------------------------•------------•--------- f ---------------------------- ----------------•---------------------------- --------------- -------- ----------------------- FINAL INSPECTION BY-------------- ''' ------------ Date- -------- �_ 7 _ ___ ---- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street Stockton, California 132 Sycamore Street 814 North "C" street Lodi, California Manteca, California Tracy, California ES-9-2M , Revised 1-57 F-RCO. i