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APPLICATION FOR SANITATION PERMIT Permit No.�°--�-�.°�•7 (Complete in Duplicate) Date Issued _;&%/j;/71_ 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... z / v i---�------------------------------------------------------------------••---.- Owner's Name Lc�_u��_II a ---------------- Phone----- ---------------------------- -Address------- ---.73`rl�'.---Yah--=s�-� Uf-n-----------------------------------------------------------•- ------------------------------------------------------------------•-•- Q JJ Phone ' — <77-X/ Contractors Name_�_yn------R,_c`�_h. .-- a - --------------------------------------------------------- ----- Installation will serve: Residence Z Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ---1---- Number of bedrooms _ ._ Number of baths _-J----- Lot size -----Sd_X-_1.?71r____ Water Supply: Public system `K Community system ❑ Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe [q Hardpan [❑ Previous Application Made: Yes ❑ No J, New Construction: Yes N No E]TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest Distance from f ndation____� -------.M ter;I____ wo� --Y C�,tr'e 1 ---• No. of compartments-------- depth_______ _________________Capacity----- X Disposal Field: Distance from nearest well-- a-n _Distance from foundation__l�-______..__Distance to nearest lot lire__�_______- Number of lines----- ----•:_--�------- L[�-- Length of-each line;o,:.',5'__J17. Width of trench----- -----------------.-- Type of filter mate riepth of filter material----- ------Total length____1. 3.0______________________ Seepage Pit: Distance to nearest 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----------------- --------------------Depth--------------------------------------------- ------Liquid Capacity----------------------------gals. Privy: Distance from nearest well- ------------------------------------Distance from nearest building----------------------------------------- El _________._____-- __-__-_-_-------_._._❑ Distance to nearest lot line------------------ -------------------------------------------------------------------------------------------------------------------------- Remodelingand/or repairing (describe):----------------------------------------------------- ------------------------------------- ------------------------------------------------........ I� --------------------------- - -------------------------------- -- - - -------- --------------- ------------------------------- - ---------------------------------••---------------- ------------ ---------•- ------------- I hereby certify that I have prepared this application an that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules an r gulations o e Joaquin Local Health District. (Signed) --- ----- --- { ar Contr�ctor) ----------------- By:__------------------------------------------------------ ------------------------------------------------------------------------(Title)----------------------------------- ------ ---------------- (Plot plan, showing size of to+, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY___,$- ------ -- --- ------------------ DATE--- ------------------ REVIEWEDBY------------------------------- -- - ---------- ------------------------- ---------p ------------------------ DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED-----------------------•----------------------------------------------------------------------------- DATE---------------------------------------7--------------------- AI -='•-r_a-.t.ins�a=�ge�------------------ --------------------------------------- -- ' reco me—nd_r{s�},ilo--nir - --=' -'- -."-_-. ----_ ---+-------'.------------------•------^------------ - jam - i '.* Y --------- $ -------,-- --'- ------- -- - - - ---------------------------------- ---- ------- ------- ------- -- ---- ------------------------------------- ---------------- -------------- e - J ------------- ------ ------- FINAL INSPECTION BY:- ------ �-�� Date--- -------------- -� ( ----------•--•------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oalc Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M Revised W-2100