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C""LICATION ,FOR SANITATION PER Permit No. rz(Complete in Duplicate) Date Issued Applica+ion is hereby made to the San Joaquin Local Health District cf rmit#a - nstruct and install the work herein described. This application is made in compliance with County Ordinance No. 5 JOB ADDRESS A��2�?ne TION_. ---712. , .e Owners Name...... ? •� �� ..__.... ----------------------------------------- •---------• --- Phone-----•- .._•-•-'-•---_--•- Address -- -- Contractor's Name - • -- ------ ' 'i' --- -------- `••- Phone-------... Installation will serve: Residence Apartment House ❑ Commercial [q'-railer Court ❑ Motel ❑ Other Number of living units '- " f�, Number of baths Lot size _!__ PPY y �Commun ty bedrooms Private ��:. .: _... •- '•---------- Water Supply: Public system N Lj Depth•to Water Table :l-rft. Character.of soil to a depth of 3 feet: Sand ❑ Gravel Sand Loam y ❑ ' CJi3y Loam❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑' No Kr-14ew Construction: Yes ❑ No F!^I ' TYPE OF INSTALLATION AND SPECIFICATIONS: `� (No septic tank or cesspool p irmitted ifp ubiic sewer-is available within200#eat: Septic Tank: Distance from nearest well_ ystance from ofoundation_.. M t r al. 0 9 No. of compartments.._ _Size_ ,X-. ___Li uid.depth__._-� Capacity. de Disposal-Field: Distance from neo rest well_ Distance from foundations' _.-_.___ g ` Distance to nearest tline Q - p YP De th of filter Ime ,� Width of trench---• .r�•------------- �'r- Number of lines--- -•__-- --- Len #h of eachmatenall ,.��r-------Total !en th---. ..� � __ Type of filter material '__ >.: I 9 .• _ Seepage''.Pit: ' Distance to nearest well_' Z��-Distance_ om `f ndation_ 10. __:Distance to nearestCot !me •��.- Number of pits.._ ____:___.__Lining material__ .__5ize: Diameter -_ " Depth -- " ---------- Cess '661: Distance fiom nearest well-----------------Distance from foundiion. .______ Lining materia!------,._:.___ ly ❑ Size: Diameter ----------- ------------•----Depth.---- " ("T1 t Liquid.:Capacity gals. Privya. Distance .from nearest well Dist ------------ ante from nearest building � ❑ Distance to nearest lot"line ----- - Remot el ------------------------ ------------4. ..... ------- ing and/or repairing'(describ .�c .__..-•------- ----------•-- --------------------------------- _._.. I --- -----------•--•--- --- -- ereby certify that I have pre pared,this-application-and that the work will-be done-in,accordance with San Joaquin County ordinances, State-laws, and rules and regulations of the San Joaquin Local Healt District. r : (Signed)_ '• i �® cfi 13y I > ------ -------------- - - ---------- (rtle) , f F-Contrd Or) (Plot plan, showing size of Iot, tion of system in relation to wells, butlings, etc., can be placed.on reverse e). ` FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---------- ------------ ----- •------------------------------•-- ---- DATE.-- -.---BY------------•-----------•-------------------...------•- - � DATE.......... .- ------BUILDING - , - . PERMIT fSSUED-__•-_-_•_-•-----------------• ,.._ -------- - - •----------------- DATE... Alterations and/o ec mendations ------------- r •------ Date:= - ------- FINAL, INSPECTION BY:._ _ ._ -- ------------------------ -------------------- SAN ---------••---------SAN .. JOAOUIN LOCAL HEALTH DISTRIQT'= 130 South American Street_ ; . 300 West Oak Street 132 Sycamore S4reet 814 North "C" 54ree+. S+ockton, Gelfornie Lodi;.California �,. Manteca, California Tracy, California ES-9 145446 ATWOOO