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q APPLICATION FOR SANITATION PERMIT Permit No. A�--�-�� • (Complete in Duplicate) - xr°-=-^--�,--•.•-�S.,.r.r� Date Issued pplication is here y` ad to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliaricf,wwitth. Counlyprdinance No. 549. JOB ADDRESS AND LOCATION--------=------------=- --- -�-krA--------------------------- o4cna�` �O�— -------------------------------------- ------- ---------------------- Owner's Name- Qe.dlr�-# `� a � �_p_ - --- -------------------- Phone--�0-5'�/------------ ��a f��? nr�-�� -- ---------------------------------------- Contractor's Name 1t. A+'R.;-s-11-7-17--y---tai ---------------- Phone-- - ------------- nsta ation will serve: Residence ®' Apartment House 0 Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _-/___- Number of bedrooms ---3- Number of baths -/---- Lot size ,S _''- _-!LQ'----------------- ater Supply: Public system X Community system '❑ Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravei ❑ Sandy Loam r] Clay Loam ❑ Clay ❑ , Adobe Eff Hardpan ❑ Previous Application Made: Yes 0 No Eff New Construction: Yes X No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well-110Ct�-Distance from founda�on_-r(A?r ' - - ------------Material_ .��t.---- [ , No. of compartments------ - Size-5+*�J-Liquid depth--4tg_"__-------Ca aci Disposal Field: Distance from nearest weli_A0-?7LZ-Distance from foundation-_Z 4_-__---Distance to nearest lot line_-_-------> Number of lines----3---------------------------Length of each line-(_4`?`- O= oWidth of trench--01/" r! ---------- Type of (liter material--- ----Depth of filter material-J-8 ---Total length----_ - ------------- Seepage Pit: Distance to nearest waif-___--. --------------Disfance4rom-~Foundation----_---------------Distance to.nearest lot line---=:-----------_zi ❑ Number of pits------------------------Lining material-----------------------Size: Diameter-----------------------Depth-------------------- Cesspool: Distance from nearest well-----------------Distance from foundation-------------------- material __---_----------_--_ ❑ Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well-----------------------------------.-------------Distance from nearest building ------ Distance to nearest la# line----___---___-----___�---------------- Remodeling and/or repairing (describe)--------------------- ------------------------------------------- --------------- - -- -- - ---- -••----------------------------------------------------------------------------------------------------------------------------•------------------- I hereby certify that I have prepared this application and that the work will be done-in accordance with San Joaquin County V�� ordinances, State.laws, and rules and regulatio s of the San Joaquin Local Health District. (Signed)--- :--- ---- ' - �` 'ex ' ------------------°--------------- -7ne C t t ---- O. rAanF on roc or -r "'~ --'--- ------- ------ ------ --------------------------------------- .¢ (Title) S'fll -7/ d_ -�------------------� (Plot plan, si �iWw g size of lot, location of system relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--_------_I- ----------------------- ----- DATE------------ ------------------------------------------REVIEWED // BY------------ t� - --- W------------- ------------------ ---------- -- ------ DATE------------ ------------------------------- UILDING PERMIT ISSUED----------------- -------------------------------------=---------------------------------------------- DATE_ 'Alterations and/or recommendations:._--_.--- ----- ----- -- FINAL INSPECTION BY:_-----_----_------ .(&y PC17'��. ComO .Sr------ ----------- - ----- Date � -- ----•--------------- SAN JOAQUIN LOCAL. HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 Nor+h "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES--4-2M 8-51 Revised W-2100