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APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. JOB -ADDRESS A D LOCATI N__�-70- 7 .--------- Owner's Name •-�_-----------• -•------ - Address_____ , Phone--- ---------- ------------------ ---- ------- _ Name---- --- - •- - ---•-�1�aQ ..--------------------------------------------- Contractor's ' Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court otel Number of living units: Number of bedrooms _ ❑ Other ❑ __-- Number of baths Lot size ---6T- ,,1 Water Supply: Public system - -----•---•---•------- Y ❑ Community system ❑ Private �--Beeth to Water Table .4-R ff. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay 0 Adobe,�F(ardpan ❑ Previous Application Made: Yes ❑ No 2j�Ade=w Construction: Yes�,�.r8- 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__ -.7r --Distance from foundation..._._��._�_.Material.............................. . No. of corrpartmenls....... .e-------- Size:.._ � .---'------Liquid depth------�•-�----•------.Ca acit ._1Q.............d Disposal Field: Distance from nearest well_._7,('_--__Distance from foundation....... .4_-'..--Distance to nearest lot 1�-- Number of lines............. r YP r l.. ..i:-------Length of each line-----,2Q Q .......Width of trench... Z.SL Type or filter material-_..- -.L--_-.-_--_-Depth of filter material-----k �' g. .....-.Total length-----2„O-.Q---------------- Seepage Pit: Distance f nearest well.....1__pQ'---.Distance om fo ndation_-_,.2_ °.-.---Distance to nearest lot line.-_ _ Number of pits.._...!.--._...--`Lining material_y !f'f-�.- /! ----_._ _._.Size: Diameter.__.. -_ �ess ool: — P Distance from nearest well �:.-__Distance from foundation----------- ----Lining material__ ------ -------------------- Size: Diameter--- ----- ---------- ----------------Depth------•------ ----- ------------...----- -- I -------Liquid Capacity. •---------------------.._gals. Privy: Distance from nearest vell______________________________________•_ _ Distance from nearest buildin ❑ Distance to nearest lot line. -------------------------------- g---- -------------•---•-----...•-- Remodeling and/or repairing (describe)________________________________________ 1 hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin Count ordinances, St a laws, and rules and regulations of the San Joaquin Local Health District, (Signed)------------ --------- (Title)- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). _. FOR DEPARTMENT U_SE ONLY y APPLICATION ACCEPTED BY................. ...... DATE --------------- REVIEWED BY DATE---� ._.. BUILDING PERMIT ISSUED-----_------- ___ 02 Z............... --------------- ------------------------•---•- ------ DATE.------ ......................................J Alterations and/or recommendations-------------------------- ---•--------- ------------------ •-------- NAL INSPECTION BY:. ------ --. / 'J?� �< ;1 -- Date. SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street Stockton, California14 North "C" Street Lodi, CaliforniaCl Manteca, California Tracy, California ES—g—ZM .�s�ns aTwaoo ,z-s+