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APPLICATION FOR SANITATION PERMIT Permit No. I (Complete in Duplicate) € Date Issued --- ----- - /5Z Applica+ion 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 AND LLOCATION. -G±. - --- : � -- ------------------------- Owner's Name- ------------ -----� _ --------- --- --- --- -- ---- Phone-. -.. -,� r7 - Address- ,1-W-1 Contractor's Name---------••----------•-- ---___- ------- -•-- ------------------ ------------------------- - ------------------------- Phone -� d- Installation will serve: Residence ?" partmenf House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other Number of living units: _-/---.,Number of bedrooms -- - Number of baths ---/.- Lot size _-- ._zz .------ -----_ ❑ ------------- - Water Supply: Public system ❑ Community system ❑ Private 'Depth to Water Table SG ft, Character of soil to a depth of 3 feet: Sand ❑ Gravel❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made:- Yes ❑ No 0� New Construction: Yes R-11-0 ❑ M TYPE OF,INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Ta k: Distance from nearest well-_ a--__Distance from foundation--- U ----,Material---Cf--e• �) No. of compartments—— -;?;.----.__-----Size- 's-6_�.��, ------- Liquid depth 'D -----Capacity- neo Disposal Field: Distance from nearest well_._4�.-.--Distance from foundation.-- " �4-------:Distance to nearest1of line.-v34__"--; ' [ � Number o{ lines--------------- -�,- - .SD Length of each line;:_.- --...- __l.,------- Type Width of french.._.-Z-- `� of filter material. - =Depth of filter material..-. --.-- Total length-----�.----- Seepage Distance to nearest welL._ ..".-._-----Distance from foun tion..... Distance to nearest lot line_--745400 __�_ Number of pits..':_ -- --Linin material- o , I �--------- g „ize: Diameter--------`-�----- --.Depfin._-��---------------- Cesspoal: Distance from nearest well-----------------Distance from foundation----------- `.--_.Lining material---------------------- ❑ Size: Diameter Depth ----------------- Uquid Capacity----------------- I --------gals. Privy: Distance from nearest well .-- ______ s Distance from nearest buildin p g❑ Distance to nearest lot line... ---- .. -- 1 Remodeling and/or repairing (descrilae):------------------------- ----------------- -------------------•--------•-•--•------- •------- - ----------=-------------------------•------------- •--------------------- I hereby certif that I have prepared this application and that the work will be done in accordance with San Joaquin Count ordinances, St la s, and rules nd'reg tions of the San Joaquin Local Health District. (Si ned g ---L (Ow and/or Contractor] c- BY� --..-- ----- ----- - ------ (Ti(Title V (Plot plan, showing size of lot, location of system in ---------------------- rel n to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------------i__---- ._._ DATE.-.-_.f. ------------ VIEWED BY--------------------------------------- ---- --- ------------- ----------- ------------------------•--------- DATE--------� - BUILDING PERMIT ISSUED------- %-------------------------------------------- - ------=-------------------------------------- ------ DATE-•-------^-.._ .l Alterations and/or recommendations: ------- --� - -------------- - ---- ' -- ---------•------------••----------- --- \--i� ----------------•-------- ---.-. �-- - - - ------------------------- FINAL INSPECTION BY:------ - - SDate-- I - - ---�--------- --------- ------------ SAN JOAQUIN LOCAL HEALTH DISTRICT i30 South American Street 300 West Oak Street 132 Sycamore Street Stockton, California 8I4 North "C" Street Lodi, California Manteca, California Tracy, California ES-9 � iasags!.Twooa