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APPLICATION FOR SANITATION PERMIT P�armit No. .___l1--�-. ---.---- (Complete in Duplicate) Applica+ion is hereby made to the San Joaquin Local Health District for, permit to construct and install the work herein described. n compliance with County Ornance No. 549.( This application is made i di p / JOB ADDRESS AND P.TION. _ -. __/--. -�"• i c - -------------- fk`.. ----- Owner -------�?� hone -------------------------------•---------•- Owner's NaName__--- .__.tf' _.---___-- •- - Address------------------------------ Contractor's Name---------- ------ Phone ------------------ Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer,Court ❑ Motel ❑ Other ❑ �� _-- Number of baths _..----- Lot size __� ---��-��-- �-�-••-------------------- Number ---•-------- ---•- � Number of living units: ___-____ Number of bedrooms _ Water Supply: Public system &Community system ❑ Private ❑ Depth to Water Table��' ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel'❑ Sandy Loam❑ Clay Loam ❑ Clay ❑ Adobe rdpan ❑ r Previous Application Made: Yes ❑ No New Construction: Yeso ❑ � + r 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-11-0 from foundation___ ______ - Mat�'a� _ .a -> = No. of compartments---JR _Size.4--o- -Liquid depth_- _ __ __._Capacity. -_- -- _-___...Distance to nearest lot line._ .. ' Disposal Field: Distance from nearest weii. '1' Distance fromtfaundation__ R. Length of each line--- �Q_.-------=---Wid#h of"trench__-- Number of lines r g -----------•- - ' Type of filter material/ Depth of filter material___ -`�,.�-Total length___ -------------•---- �It ......Pit: to nearest lo` line . ` -- d�.Size: Diameter_ .. Depth-_--- ------------------- Number of pits------ ---------------Lining material(:- � - � --� -�., Cesspool: Distance from nearest well_________________Distance"from foundation___._._:__._-'..___ Lining material------------------------------------- Cesspool: ___....___-.____._.__--- _ als. ❑ Size: Diameter----- ----------------------- -----..Depth------------------------------------------ ----------Liquid Capacity-- .-------------- -----g Privy: Distance from nearest well-.----------- --------------------------------Distance from -nearest building----------------------------_ ----------- ----------- :----- ❑ Dis#ante to nearest lot line ---'-------- -------------------------------- - -------------- Distance ;- _ �4 Remodeling and/or repairing (describe}:_..___.. = - " F"-' ---••-" ------ -- ------------------------=-- _ ____.___________________________ , prepared ns of the 5 n Joaquin Local }�o s ...----•-.--------------- --------- ;: ! hereby certify that I have re ared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and re u a � q Health District. ------ Owner and/or Contractor) Signed ---�- { ------ E - lel N ----------------- •---.{Title) ------------- 'n a of lot, location of system in relation to wells, buildings, etc., can be placed bn reversgOde). (Plot plan, showE FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED 13Y----------------------- ----- =" DATE_._ --• Y REVIEWED BY----- ------------------- -----=--------- --- ----------------------------------------------------- DATE ------- DATE--- ------- - BUILDING PERMIT ISSUED------------------------- Alterations and/or recommendations: - -_'-._-- -' - -- :-------•------•--------•------ 14c- --- --------•-----•-----•---- ----- -•-----•----•-- ------ --•---- --------------------------------------------------- -------------------- ----------- ----- ------------ ------------------ / = ------------------------ FINAL INSPECTION BY:--- - - ---• • --------------------- Da}e-_... ._ SAN JOAQUIN LOCAL HEALTH-DISTRICT 132 Sycamore Street 814'North "C" Street J30 South Ame]61,,` Street 300 West Oat 5traa+ Tracy, California Stockton, Celii tet,*+ Lodi, California. Manteca, California Y r M1 `} E S—j 145496 ATWnI w'�.