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APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) Date Issued ,ppliCa4lon is hereby made to the San Joaquin Local Health District for a permit to onstru and instail the work herein described. This appication is made ;n compliance with County Ordinance No. Ir49 549. JOB ADDRESS AND LOCATION_.-... t . ............ Owner's Name...._..._...__. :_01111 'P..............- ................................ .. Contractor's Name................ .... ... .. ... Phew Address................. .... .. ...... Phone. Installation will serve- Residence patment House f] Commercial E] Trailer Court 0 Motif Fj Other ❑ Number of living units: Number of bedrooms ..,�. Number of baths Lot size .......... Water Supply: Public system I^'] Community system C] Private 1e,pth to Water Table . f, Character of soil to a depth of 3 feet: Sand El Gravel 0 Sandy Loam E] Clay Loam El Clay (!T�Ado6a 0 Hardpan E] Previous Application Made.- Yes n No V-**New Construction: Yes [A�00 TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank at cesspool permitted if Public sewer is available within 200 feet.) Septic Tan, r.1 =�Fst Distance from nearest we. 5Xarice from foundati4ioF��aferial._,_..... Tan No. of coapartments ... ......_.___Si29..............................Liqutd ...... Capacity.............. Disposal s Distance irorn nearest we0,/"._..._.Distance from foundation.. to nearest lot Numaer of cines....... h 0.� each line-._,, ..... Width of trench"._ ell Type of filter of filter material_)... lerigih_...... Seepage P' Di0ance to nearest wo:i.Ax.V........Distance from fo+4dafion_,,7_j.'..e Distance to nearest lot Iine../d Number of pits_S>14�.....Uning material...11,414 Size: Diamefer.-J.%X. .....�Depth. __..oL07_4_ f Cesspool: Distance from nearest well... ............Distance from foundation.-........._..... ..Lining materiaL. ❑ Size: Diarnefer..... . ........ Depth.................... _.............____...Liquid •Capacity....... r-rivy. Distance from nearest well........................... .........._.. Distance from nearest building,................................... -- -- Distance to nearest lot - .. .......... . Remodeling and/or repairing (describe)%................._42 .......... ------ 4-4- ............. . ... ...... ....... ....... .... ... .... ........... ............. ........ ......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)--... ._........._................ ....... ,._.......................................I—- ............... : ......(Owner andItl..... ._._ r Contracto�]- Iey:__............... ................_:................................................I......................... ------- - ..... .. .. ............. . .......... (Plot plan, showing size of lot, location of system in relation to w6l1s, buildings, e+c-, can be placed on reverse side FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY.....`....... ....... DATE.__...... ...... REVIEWEDBY.. .... ............................... . ............ DATE..w.. ___f........ BUILDING PERMIT ISSUED....... ................1__......._........ ........... DATE... .._._................`....... ATE.................................... Alterations and/or recommendations:-._.,..... ................ ............ .................................... ......... ....w......_....._ ..... .............. ................................. ----------- ......... .......... ...................... ........................................... .......«............................._........... ..................... ........•.....«.-.....«.«,...................._......................«.._.......................«............«.,.._................... FINAL INSPECTION BY....... Date......_977:�__.-'j.................. SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 Wad Oak Street 132 Sycamore Street 014 North "C"Street Stockton, California Lodi, California Manteca. California Tracy, California C=-9-2m -416-W-