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ll-- APPLICATION FOR SANITATION PERMIT p � Permit No. ..� fi (Complete in Duplicate) �, e-:1 3� �, Date Issued _ (`3 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 LOCATION-------P_I-- ------ -----t---- ti`G Owner's Name ` " ¢ ,--------t,x- f------------------------------------ Phone/114 ----------- Address-----------Z—1-; .. V-4-0& 1 - " --- -- Contractor's Name------ l� j;y ... � ` `'� ----------------- ----- Phone_ ... Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ------ Number of bedrooms --1. Number of baths ___4_ Lot size ___ -------- ------------------------------ Water Supply: Public system 2- Community System❑ Private ❑ Depth to Water Table ft. Character of soil to a depth of 3 feet: Sand ❑ Grave! ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe R Hardpan ❑ Previous Application Made: Yes Rr-�o ❑ New Construction: Yeso� No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: , \� (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest wellWft0e ___--Distance from foundation_--�1j __._Material__ idC�___ t='. ------------- ® No. of compartments------------ --------Size----j0'1A--_fA_- ----Liquid depth---------9lpG---------Capacity.__?0+!---------- Disposal Field: Distance from nearest weli_A/-t �.-Distance from foundation__-/91-1141-..Distance to nearest lot line.-___ _... ® Number of lines-----------------------------------Length of each line------?8'--14_,5--------Width of trench-------".If ---- of filter material___Tr_1�iI��—Depth of fiite terial___1-_�___._---___Total length-------7 -_--,----_--_--_-- Seepage Pit: Distance to nearest well-.-/�,c+.N_g,,-----Dis ncelfrom foun tion------ .:.Distance to nearest lot line------ __. p /-----------Lining ma rial.:___Ri_C,�_ ---- ze: Diameter-------- .�--------Depth------ .�t Number of its._..___ _ •--------------- Cesspool: Distance from nearest well-----------------Di nce f ' oundation----_-_____._---- lining material-__._---..____--_.._ Siza: Diameter--- -------------- ---------Depth"-------------------------------- ---------------Liquid Capacity---.------ ------.gals. Privy: Distance from nearest well------_---_ _ ________________________________Distance from nearest b0clin ' ❑ Distance to nearest lot line---------- �. Remodeling and/or repairing (describe)--------------------- --------------------------... ` -------------- ---------•-------------------------•-•----------__-----•---------------------------------------------------•-------------------------------------------------------------------------------•--------------------------- 1, hereby certify that I have prepared this application and that'the work will be done in accordance with San Joaquin County ordinances, St fe laws, and r�gS tni fjoyhtians of the San Joaquin Local Health District. T (Signed]..__ Septic Tank Service -7206,So:E;d;iadb---HO-24046 - -- V------------------- - w or Contractor) BY: $o�Icton,.Calif-- - --_�-..�-_ .Lcc {Title) -------- - - --- --------------------- (Plot plan, showing size of lot, location of system in relation to w buildings, etc., can be placed on reverse side). `FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY - ------�- DATE------ REVIEWEDBY-------------------------- ----------------------- ------- DATE -----"-W-�--...`----------- -- --------------------- l3UILDING PERMIT ISSUED ----- DATE----------------- 4 - - Alterations and/or recommendations:.-----1----------. _ ..-- - ....... ` i7 ----------- ------------------------ - - _ _ __..._ _--___ ._.-._ _. ..-.f_. __. _-_ _._._ __ ._ ._ _ _ ______ ___________________________ s - FINAL INSPECTION BY:..... �i� .�--------------------•---------------- Date--- . -------•-•------ ---------------------------------------- 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 prw000 12-54