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APPLICATION FOR SANITATION PERMIT Permit No. _ ----4--- w , (Complete in Duplicate) Date issued 71-70A-) -_ `7 Application 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. + •L. .LJ { ST , r I s-a JOB ADDRESS ANDOCAT{ON____._, Y_e- Owner's Name--------- _Y'_Q-" --- ------L. -�%Y_e--!-__ q ------------- ----------_------------------------•------------------------- Address-------._------------- � '•.-•'�...__�-�x � dr 1 �>'� --- ---- Phone------------ i Contractor's Name__.---------•------ --------- - ---------------------------------------------------------------------------- Installation will serve: Residence ❑ Apartment House ❑ Commercial A Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ________ Number of bedrooms -------- Number of baths __Z__ Lot size ___ --------------------- 4 Water Supply: Public system ❑ Community system '❑ Private ® Depth to Water Table,b--?_'4ts Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay El Adobe ® Hardpan E] Previous Application Made: Yes ❑ No X New Construction: Yes ❑ No ❑ { t TYPE (NINSTALLATION seSpticLta k or e pool permitted SPECIFICATIONS: c sewer is available within 200 feet.) r � � I �j G 1 Septic Tank: Distance from nearest welL �_-_____Distance from foundat on-__/ -__------__.Materiai_it__________ _ ___ f' No. of compartments_______ __Size---- _ __� Liquid depth----3_--6-----------Capacity.._1Fj1d_.,%1X i __'S�_. '-Distance from foundation11_��-_ �______--Distance to nearest lot line.___�}-_______ Disposal Field: Distance from nearest well Number of lines----------�---------------------Length of each line-------_7_�-- ----��----.Width of trench_--- - j-- Yf Type of filter material____ d _ '____--_Depth of filter materiaL____� _______Total length______---�d---______ _�__. vk � Seepage Pit: Distance to nearest well----------------------Distance from foundation-------------------Distance to nearest lot line__-___________--- STI f ❑ Number of pits--------------- ---Lining material----------------------Size: Diameter----------------------Depth_4----------------------------- (m' iCesspool: Distance from nearest well-----------------Distance from foundation__-----------------_Lining material--------------------------________- Size: DiameterC ❑ --------------Depth----------------------------------------------------Liquid Capacity------------------- -----g --------------�-------- Privy: Distance from nearest well----------_---------------------------------- Distance from nearest building----__________________--.______________-. ❑ Distance to nearest lot line.------ ----- ------------------------ ------------------------------------------------------- Remodeling and/or repairing (describe):______ e1 _ ______1_-____ r .,..--------a x-e---- 1 s L . _� ... ------------- - --------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ----------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. ,,� ., ....... _ _(Owner and/or Contractor) (Signed)--------rwinzgl ------•-•.: --------•- �- BY _ -----------------------------------------------(Title} , �•''' '�.! (Plot plan, shize of"lot, location of system in relation to wells, buildings, etc., can be aced on reverse side). FOR DEPARTMENT U E ONLY ACCEPTED BY """ ------------ ---------------- APPLICATION ' DATE REVIEWEDBY---------------------------------------- --- ------------------------------ ----------------------------------------------- DATE----------------------------------- '-. 7 BUILDING PERMIT ISSUED-- --•--- l, et------------------------ DATE .r # Altera ;'ons and/or rec m en at' - _ -- -= "� '+ ------i --- ------- 7 {---- ®� „- ev I FINAL INSPECTION BY--------------- ---- 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 9.51 Revised W-2100 i