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Permit No. ----_------------ APPLICATION _--_ 459�- FOR SANITATION PERMIT f (Complete in Duplicate) Date Issued --- Applica{ion is hereby made to the San Joaquin Local Health Disfiict for a permit to construct and install the - erein described. " This application is made in compliance with ' County Ordin N . 549. --JOB ADDRESS ANQO ATION.�-1-�.nt --- � Q dOwners Name EP hone x Address---------- 1 --••o------ ----------- ..........................................------------ Contractor's.Name----------------------- ^��`7 "`' Phonel.4%. �f! ________________________ _.._ _ _..__ ... _______ _ __ E_ Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court p Motel ❑ Other �/�p�ee f/ - r Number of living units:=____ Number of bedrooms -�_._.. Number of baths -1----- Lot size --_-G1Q_. _.f -------------------___.___._ Water Supply: Public system 0 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.K Hardpan ❑ Previous Application Made: Yes ❑ No New Construction: Yes E] No TYPE OF INSTALLATION AND SPECIFICATIONS: a (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tans„Ai(� Distance from nearest well___-------------Distance from foundation--------------------Material------------.-------------------------------- "... ❑ � No. of compartments------------ -------------Size----_--------------------- Liquid depth--------- -- -------------Capacity----------------------- v _ :..; Disposal Field- Distance from nearest well-----------------Distance from foundation- ---_-___-----._..Distance to nearest lot line-------__--._.--- , } El�f$_ef .Number or lines------------------------- ---- ----Length of each line----------- ------ -----------Width of trench-------------•----------- 1” Type of filter material-------------------------Depth of filter material-----------------------Total length------------------------------------ �. — -�� 6 L�,c -Fr��r#cia ' �Q_---.-__.Distance to nearest lot line , ;_.;___----_Seepage Pit: Distance to nearest wel�/ ----- 8iCn u ton___'Number of pits.. —�_---Lining mat /.i. r.__.Size: Diameter-_-3-__-...".._..__..Depth___2.�---------------- Cesspool: Distance from nearest well_-_-_----._.. _-Dioundation------------------_Lining material---------------------------- -------- I El Size: Diameter = Depth- ------------------------ ---------------------Liquid Capacity-------------------- -gals. 1 Privy: Distance from nearest Well__Y------- ------------------------ ------Distance from nearest building_---------.--------------------.---------- ❑ Distance to nearest lot line------------------ ---------- --------------- -----------------------------------=---------------•-------------- ------- -------------------- . C and/or repairing (describe): --- ------------------------- ------------- Remodeling - - = ---------------------------------F -------------------------------------------------------------------------------- »...._____.___.__._________..___._._ I ------------------------------------------------------------------------------------------------------------- -------------- ._. ......... __ # 1 ! r I hereby certify that:l h prepare is application and that the work will be done in accordance with San Joaquin County ordinances, State laws, an r and regul tions of a San Joaquin Local Health District. --- ------------ '----------�eHnreerse -(Owner Contractorl (Signed)--------------------•------------ --•-�-- ----------,-- -�-�f *By:---------------------•----- ;�------ --- ------- --��-------- -- = _(Title}- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be pla side). s i I FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-- €---------------------- �----- - `-------:---- DATE-------- .e__ -v i ---- - ------ ---------------------------------------- DATE---------- REVIEWED BY--------- ------------------------ -- --------- -- � - - - �--------------.�......-------------------- BUILDING PERMIT ISSUED ------ ----� ¢ -•-- DATE-------•-- - } -------------- Alterations and/or recommendations:-------------- ------ . ........... ----- ------- - - - --------=--------------•---------------•--- = ��--------------------•---"---- - - -- ------------- - -------------- - -------------------------•-- --------------- ---------------------------------- I ,`- ------------ --------------------- •--------- --------------------- ---- >? ----- --- --------- --------- ----- -- -----. _ _ . . -------------------•----- - -- ----- --------- --- ...... -- ------- ------------------------- ------ -------------------------- FINAL INSPECTION 'BY--- -- -- -- ----_----- f --t-- rL SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-•'9-2M 145446 A7WOOD 12-54