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APPLICATION FOR SANITATION PERMIT Permit • (Complete in Duplicate) Date Issued Application is hereby made to the San Joaquin Local Heaith District for a permit to construct and install fh6,-1;2r'k herein described. This a�pjicafion is MadeAn Compliance V6 County Ordinance No. 549. J7wr:tv- IS JOB ADDRESS A CATION W-+ .:6xi AA11AA1_ if P 0 64 Owner's Name....--=- Address....... ......... Contractor's Name....... _61_r�Rf-.5, t. Phone... Installation will serve: Residence Fj Apartment House C] Commercial El Trailer Court Motel 01her Number of living p. Number of bedrooms Number of baths ........ Lot size Depth to Water Table Water Supply: Public system 0 Community system f] Private 0 _0_ ft. Character of soil to a depth of 3 feet: Sand C1 Gravel 0 Sandy Loam[] Clay'Loam, El Clay Adobe 0 Hardpan 13— ❑ 1 1� Previous Application Made: Yes El No a New Construcf;on: Yes X No TYPE OF INSTALLATION AND SPECIFICATIONS. (No septic tank or cesspool permitted if Public sewer is available within 200 feet.) Septic Tank. Distance'from nei est Distance from foundation., Mat No. of compartmenfs_': ' do" ..... ..... - IX--a)Sill--$ 47�D..........Liquid Disposal Field: Distance from nearest well, from foundatior-_./ pth.- _jO�"___Distanca to nearest lot line/ Length of each Width of trianch—,,44. Numbar of lines.-. Typo of filter me .�"_Depth of filter mator;aL,.,-/ .......... Seepage Pit: Distance to nearest Distances from foundation.. ...._Total ❑ Number of pits.................. ___-Distanca to nearest lot line...... ......Size: Depth............... .........i Distance from nearest Distarics front found atiOn... ...... .....Lining material..-........ ........... Size: Diameter........_.. Privy: ...... ................ Di _Liquid Capacity.._. Distance from nearest well..... ❑ Distance to nearest lot I'm . .. ..... .............Distance from nearest Remodeling and/or-rap"_ a .... d-1Z i _ 7 �A ---------- . .............. ::. ....._..»...............». .. .................................. ............�........_....._,.....:::: _._..._.._.»........................I....1_.......... ..................... I hereby certify that I have prepared this application and that the work will be done in accordanca wifitSan Joaquin Countj�,,, jj ordinances, liews, and rules a I regulations of the San Joaquin Local Health District. t?.- _.. ..... ....�i 111/1 -17% (OwnerAnd/Or Contractor) By........... Z.fix.A....... .... .. ....... ...(Title)... (Plot plan, showin size of lot, location of system in lafion to wells, buildings, etc., can be placed on reverse side).-,, FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY I ............ ......... DATE REVIEWED BY-,..................... DATE__� BUILDING PERMIT ISSUED_ ........ -- -------- ......... AI+*ra+ions and/or recommendations:-,............ .................. ........... ........... .......................................................... ...................... ....... ........ ............... ............. ................................ ......__ «........,.w_,_........ ............I............. .........._..............................4........I.....,.-......-..-..-.--....—.-..-.,.-.---....... -» .. .-..-.-"............. ................ .........._..................... ....... ....... FINAL INSPECTION Date_... ............... SAN JOAPUIN LOCAL HEALTH DISTRICT 130 South American Street 300 Was+ Oak Street 132 5yc* ,S+r40f Stockton, California Lodi, CaliforniaMQr* 814 North "C', S+rs&f cartformsTracy, C*11farj%;& ES.9--2M 8-511 Revised W-2100