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15� APPLICATION FOR SANITATOPERMPermit No. _- - - - ' (Complete in Duplicaten Date IssuedApp' ion is h reby made to the San Joaquin Local Health District for a pall the work herein described. Th' app icafion is made in compliance with County Ordinance No. 549.O3s '! i11" rte #� �� + dam- 2! JOBA15DPESS ANDLOCATION , � C iT � 1Y1 �? ?�✓ Owner's Name / _ 7 �!9 --.-_..�C�_a �1 G-`I Gid 7i-1 b7., '. lSj------ Phone-----------•------------------------ Address---------------- ---------------•--•----------------•--•----•-•-•-•--------------------------------------- Contractor's Name----------------- -------------------------------------------------------------- --------------------------------. Phone------------- ------- "stallation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailsr Court ❑ Motel El Other Number of living units: --- Number of bedrooms _-�Number of baths -9-- Lot size ------------------------------- Water Supply: Public system ❑ Community system ❑ Private EB- 5epth to Water Table ---- ft. Character of soil to a depth of 3 feet: Sand e Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: Yes ❑ No Qi-"New Construction: Yes ao'�No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: 't rn (No septic tank or cesspool permitted if public sewer is available within 200 feet.) v1 Septic Tank: Distance from nearest well-------0----Distance from f0undation0;V .Material 1�C7_ -- �r� ,.------- ZNo. of compartments-----------4-1--_------Size---- ----�1 /�l„__-I uid'depth--------------------------Capacity__%_j11jQ - Disposal Field: Distance from nearest we€i___-.�------Distance fro oupd ion-----4.!�---------Distance to nearest lot �� Number of lines-----------------1--------------Length of c in _ (2. i•A--' ------Width of trench-------.2-y-_.-----.-__---.... _ Type or filter material�._jet_e'k'•__Depth o �l r .6terial------/-S..-_---_Total length--------14--0------------------------ Seepage Pit: Distance to nearest well---------------------- a rom ounda±ion_-----_--__--_--. rDistance to nearest lot line-_-_------__---- , ❑ Number of pits Lining mat i ------ ----------Sizer Diameter.----------------------Depth-------- ------------------------ r Cesspool: Distance from nearest well--______________ ance fr m foundation------------.------.Lining material------------------------------------- I ❑ Size: Diameter ------ - epth------ --------------------------------------------Liquid Capacity---_----------------- ----9ais. Privy: Distance from nearest well -- -- ----------------- -----------------Distance from nearest building------_-__-----_-----------.--------------. ❑ Distance to nearest lot line------ f� Remodeling and/or repairing (describe)---------geIAOAZ!n----. + _ _-..P=�tl ------- !� --------------- ----------- -------- Fes"__-- -0C;,?e2,,q------.6-no-6,47-------------------------------- •_.... --------------------------------•------••--------------------------------- p ----14 ------ Ld -..Y - .,...----------s �y4.�+[11 C�-- 1l- / (.6G1.. -----•- I hereby certify that I haverepared t as a plication nd that the work will •a done i ccordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed)__. _- lJ (Owner and/or Contractor) y:--------------------------------------------------------------- ----------------------------------------------------------------(Title)--------------------------------------- ------------- I t (Plot pian, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). i FOR DEPARTMENT USE ONLY h APPLICATION ACCEPTED BY---- --- _c ,r " DATE------_ '____--- `,c�, -- ---------------------------------- REVIEWED BY------------------------------- ------ - -- - 1------------------ DATE--------- .. BUILDING PERMIT ISSUED '€ ------------------- L ------ DATE------ s</ Alterations and/or recommendations--- ------- --------------------------------------------------------------------------•------------•---------------------------•--------------------------- ----- ---------------- t Gni a � G3 /L__`O Y�-lel- l. •`' -`� -2•,___;7---4-'))- `!� S ------------e rr'.CQt'2 d I 7`3d)M`- C+C---&,=..-.Q _7-:,44''7 =� `7'le -cG4Lsl--.-TCJP-_-__�I 1-_1,1VAz, T M2 J_0�00C,4 4L,�_ r-�4ciLerrerrour-d "AI& `' FINAL INSPECTIONBY:.- ----- / . Date------------ ;_0----- 5 SAN J QUIN LOCAL HEALTH DISTRICT 7 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C” Street Stockton, California Lodi, California Manteca, California Tracy, California 4--2M Revised W-2100