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APPLICATION FOR SANITATION PERMIT Permit No. .!�x_Co 4, (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 EWis_madejn,co2plia9ce. with County Ordinance No. 549. JOB ADDRESS AND LOCATIO _ _ " -- --- - Owner's Name------------- o a- l1 --------------------- �' a � -------------------------- ----------------------------------- ------ Phone--- -------•-----------•------------ Address T --------------- Con'fractor's Name--------------------- —' -------• - - - ------ --------- ----- Phone .------•------------- --•---------- --- ------------------------------------------- -- ------ - Installation will serve: Residence 9� apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _-/r-- Number of bedrooms �� i _- Number of baths -_ _- Lot size --___ � � - •- ---- Water Supply: Public system ❑ Community system I43--Private ❑ Depth to Water Table Z ft. Character of soil to a depth of 3 feet: Sand E❑ Gravel ❑ Sandy Loam 0 Clay Loam E] Clay p Adobe ®�ardpan E]Previous Application Made: Yes [❑ No 99' New Construction: Yes [�'No ElFHA/VA: Yes Fo+—•No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) Septic Talk: Distance from nearest wO-----=---Distance from foundation----./0 -------Material--"_( No. of compartments_--_ �• ------ mac. - -------------Size_% -----_--- �0-'Liquid depth----tom' --------------Capacity ---.1��"-- � Disposal Field: Distance from nearest well._--_ Distance from foundation---"___ e - .,��__-_""_.Disfiance to nearest lot line"_----�_-_---_ (� Number of lines-------,�*---------------------Length of each line------ Type of filter material,/ + Width of trench Xw_ . -P_ 1 Depth of filter material--_»/!:------_Total length------ --------------------- Seepage Pit: Distance f nearest well...... ----Distance from foundation_,, Q ----.Distance to nearest lot Number of pits- ------------ - -_--__Lining material__¢CQ4-�.__Size: Diameter-„3. _.-___pepth__..�, ' �1 ,,� Cesspool: Distance from nearest well---------------- Distance from foundation Lining material____- ..__-.-- - ❑ Size: Diameter ------------------------Depth----- ---------------------------------------------Liquid Capacity----------------------------gala Privy: Distance from nearest well_-- Distance from nearest building--------------------------------- E1 Distance to nearest lot line___--_-___ -------------- Remodeling and/or repairing (d _-. escribe): __-- -"__-- { = ---- - ------------•---- •------- -------------- -- I - ----------------------------------------------------------------------------------------------------------------------•----------•---------------•- ------- ----------•------------------ I hereby certify that I have prepared 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 Health District. (Signed)�Y� - ------------------ �- rContractor) Title .I )---- (Plot plan, showing size of lot, location of sy m in relation to wells, buildings, etc., can be placed on reverse side). S FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------TLT3..Q ------------------ ------------- --------------------------•---------- - DATE"--------- 5-7 REVIEWED BY---------------------------------------- -------------------------------------- - ---•----------------------- UILDING PERMIT ISSUED- -------------- DATE- --- ------------•.------. -------------- ----------------•-�- --•---- DATE.-------------•--------------- ----- - ------------------------------ Alterations and/or recommendations :_----_._--.---___." _--.___ . sn ► 4- Y ----------------_ --- ----------------=- •--------- -------- l -------------------------- , -------------------------------------------- FINAL INSPECT Date-------��- - ----- ------------------------------------ SAN ------------ ------SAN JOAQUIN LOCAL HEALTH DISTRICT 00 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street ° Stockton, California Lodi, California Manteca, California Tracy, California E5-9-2M , Revisea 7.57 F.P.CO.