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APPLICATION .FOR SANITATION PERMIT Per-mit No. ..- q_7`f (Complete in Duplicate) !4,!�g �, D a issued _---------- -- Applica+ion is hereby made to a San Joaquin Local Health District for a permit to onstruct an install the work herein described. This application is made in compliance with County Ordinance No..549. r�5"f� 7t s✓��c sr-• �� l 7_2-1-c} 15 J B ADDRESS AND LOCATION'. .-"-" - L., ----- - . ..�- - �.�� - Owner's fl�° G4 -------- ---- ------------- Phone-- �-- -'� Address-va '. .. �.... Lam " - 1 .!IlJ_-Ili- -Q. r_�(��_�! Contractor's Name__- -1-A --------------- ---------------- ------------------------------------------------------ Installation will serve: Residence 5U,4Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ i a Number of living units: --_-f_flNumber of bedrooms -Z1_ Number of baths J---- Lot size ------ - Water Supply: Public system ❑ Communitysystem /�� y ❑ Private �epth to Water Table �1-_ ft. 1. Character of loil.to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe(Hardpan ❑ Previous Application.Made: Yes ❑ I No 94-1KJew Construction: Yes SNo ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic T cI Distance from nearest well-- Q.-__----Dista frim foundati n. A- ot �� I No. of compartments..---Z � � qSize- wd dy_ - -- �_Capacity p Y >( ' Disposal Field Distance from nearest weft--__--.-___---.-Distance from foundation--------------------Distance to nearest lot line----------------• " Number of lines----------------------------- ---Length of each line-----_-_---- - ---------- -Width of #ranch-------- ------------ ----------=---, � Type of filter material----- ------------------Depth of filter material-----------------------Total length------------------------------Seepage Pit: Distance to nearest well----------------------Distance from foundation------------------- Distance to nearest lot line--._..---__-----_ ❑ Number of pits----------------------Lining material-----------------------Size. Diameter--------------------------------------Depth--------------------------------- Cesspool- !. Distance from nearest well-----------------Distance from foundation--_-.-- -.Lining material _--.__------_-.-.-_-.---_----- �' ❑ Size: Diameter------ ------------------------------De.pth-------------------------------------- - -- -Liquid Capacity----.---------------- -----gals. Privy: A Distance from nearest well-------------------------------------------------Distance from nearest buildin ❑ Distance to nearest lot line---------------- 9 ----•------ ^--- ---�------- ------ ------------------------------------- Re deling nj.d/ar repairing (describe}:-..._ ._ �( ,-� -_ ------ 1. c = - s xd.� ..;_:_y � ------------------------------------- - -- ---------------------------------------------- ------------- ----- ----------__-------- -- --------- -----••--- ------ --------------- ------- --------- ••-----------------------------------------------------------------------------------•---------------------------------------------------------------- ----------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, St hte laws, and rules acid regulations of the San.Joaquin Local Health District. F F (Signed)--------- ... . --- - - � ,-- -- - -- - -- - ----- - -(Owner and/or Contractor) By:._... -------L. T1#Ie ( --------------- (Plot plan, showing size o lot, location of pys+em in relation to wells, buildings, etc., can be plac!dq reverse side). t } II FOR DEPARTMENT USE ONLY APPLICATION)ACCEPTED BY -____-------------------- -- - Sl -- - - ---=------- ---------------- ------------- ------ DATE......,.--- •------------- ---------•------------ --------- REVIEWED BYE----- ------ -- =•------------ ------------------------------------------------- ------- DATE BUILDING PERMIT ISSUED----------- --- ------ DATE..__"T�------------- ----------------------------------------------------------------------- Altera+io s•and%or recommendations:----------._--_ 4, -� ------------- -----------{ LI ------ ------------ A- -- -- -•-------------------- ---`----''`--� ------- ` - -- - - - --- -----~- `tet. - - ---- --------- t ------- -------- j " FINAL INSPECTION BY:._- . Date - ------ _ � . --------- / L fR'J SAN JOAQUIN-LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stoekton,;,California Lodi, California Manteca, California Tracy, California �i ES-9-2M 1-44$ Do