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V67,rc,(�, -0. APPLICATl4N I'OR SANITATIQN PERMIT Permit No.lcy� (Complete in Duplicate) Date Issued __-. 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. I JOB ADDRESS AND LOCATION__775 _ -------- 1101 1 ---------------------�# - ----._'7"�------� - ' --------------------•---------•------�---------------------------------- Owner's ,• :------ -----------= ------ --------------=-=----------------------------- Name Phone ✓�` ��"Z 3 T �------�------------ ---- s: , Address--------------------------------------------------=- -- - ------------------------------------------------•--•-••-"-----------------•--......----...---•----------------•---•--• k Contractor's Name------ [ `� `"4`'." � T ------- Installation Phone. I , � -- -- ---------- �- ,v Ala Installation will serve: lResidence Apartment kElouse E] Commercial ❑ railer�Court p Motel ❑ Other ❑ Number of living units: ___ Number of bedrooms1_CX_. Number of baths __/____ !Lot size __1.4`__,XA_7---------------------------- Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table _i ft. Character of soil to a depth of 3 feet; Sand Q ravel-E] Sandy Loam❑ Clay Loam ❑I Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: Yes ❑ No New Construction: Yes a. No ❑ TYPE OF INSTALLATION AND SPECIFICATION: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic nk: Distance from nearest well—A—Xe_Distance fror�foundation-_)_a__t_:_____Material_- _�-'.___�------------- �i of compartments------ < _r3Sizes�5:. �X A ____•Liiqgd�id depth y1�...___-----------Capacity. ?47A Dispose Field: Distance from nearest well_ �N�=.�Distance from foundation__, _Distance to nearest lot line____�!a______ Number of lines.-.---- ........- Length of each line--- 3p3�-_ __-:r_:Width of trenc ------------------ U[ " Type of filter material--__S,__� -iDepfh of,filter material _-1_ _ "_._____Total length__-_-___53_a__________- p � �._ .__�__________Linin material__ .�'►�___�4_.Size n____ Distance to nearest lot line____-s_�______ p/ See a Pit: l�lumabee of pitto s-1 from fo ndatio Diameter__.12_e_..________Depth-'-----,;'-,:--------------------- Cesspool: Distance from nearest well-________________Distance from foundation__.___.__._______3Lining material-------------------------------------- Size- _._____ ________._-____.Size- Diameter------ ---------- - -------- ------Depth ----;-- --------------- ----------` !------t squid Capacity----------------------------gals. Privy:. Distance from near`est well_'-------------------__------------------- r__._'"Distance from nearest building------------------------------- Distance to nearest lot-line----------------------- i fi- - ,_ - � Remodeling and/or repairing (describe):___________________________ y '�• � c :ars ------------•--------------------------------------------•--------------------------------------------------------------------------------------------------------------------------------------------------- --------------------------------------------------------------------------------------------------------------- r --- I hereby certify'+haul have prepared this application and +hat the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and�ns of the San Joaquin Local Health District. (Signed)-- �_UP _ �'� O or and/or Contractor .cs�.L. By: = ------------- ------- --- ---- ----------------------------------------------- " (r+lel -- ------------- (Plot plan, showing size of lot, location of sys em in relation to wells, buildings, etc., can be placed on reverse side). - t FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----- ------- --------------------------------------- - -------------_----------- DATE--------- ----- -- ----------- REVIEWEDBY ----------=--------------------------------------------- -------------------------------•---------------------- DATE------:--------------------------- BUILDING PERMIT ISSUED------------------ - ------------------------------------------------------------------------------- DATE----------------------------------- - - ---------------------- Aitera+ions and/or recommendations:.-==--------------------------------•--------------•-••--------•------•-------- -----------------°-•---------------------- --------------------------- FINAL INSPECTION BY:. ------------------------- l;Naakl------- ------------` 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 -x ES-9-2M ; ' Revised W-2140