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i� Permit No. ,X71-"-- �, � APPLICATION FOR SANITATION PERMIT (Complete in Duplicate) Date Issued Appication is hereby made to the San Joaquin Local O d alth DiNoc fora permit to construct and install the work herein described. l his application is made in compliance with County --------�------- -- 49 ---- ----•--•-------------•------------------------- JOB ADDRESS AND LOCATION______________ � ------------------- �G:-��''-!'-I--�-/- ----•- r X92-�-+�--- ----- Phone----------------- Owner's Name--------------------- - <_ - Y1 1. Address--------------------- - • ----------------- ------ ------•------- Phone--------•-------------------------- Contractor'same_-------•---•--------------- Other Installation will serve: Residence Il Apartment House ❑ Commercial E] Trailer Court [IMosel ❑ er ' . `YNumber of baths -t.-_ Lot size - 1 Number of living units: ___�"_ Number of bedrooms ________ Depth to Water Table ________ ft. Water Supply: Public system 9 Community system ❑ Private ❑ p pp Y� Adobe � Hardpan ❑ Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam❑ Clay ❑ Previous Application Made: Yes ❑ No ® New Construction: Yes & No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if pyblic sewer is available within 200 feet.) ` l prr� /17- ----- i from nearest well"- dr9'y____Distance�from,founzlation_____ __ Material___ ' ------------ Septic -� .- k Septic Tank: Distance �f�! No. of compartments----------fes---- -----size-A.-X_�X Liquid depth ��L Capacity ` �i ot line _�-� _ Disposal Field: Distance from nearest weal___________ ___Qistance from foundat�n--" ��,--DVVEdth ofttrenchest 1 -----------Length of each line_-r__ ��-- ------" Number of I•snes----------3--------- g ,! th---------1--��-�---��---------------------- Type of filter material- Depth of filter material----)f--------------Total len g Seepage Pit: Distance to nearest well----__Linin material Distance from foundation Diameter_-""Distance to nearest lot line----------------- Seepage -------------- F1 �• ❑ Number of pits__-"" g ' Cesspool: Distance from nearest well_________________Distance from foundation _____ --.Lining material________-_______--- els. Depth --Liquid CapaatY----------------------------g ❑ Size: Diameter----------------------------- p Distance from nearest building----------------- ----- Privy: Distance from nearest well-------------------------- ----------------------------------------------- ------------------ El Distance to nearest lot liner___________________ ------------------------- ---------"----•----------•---------------- - Remodeling and/or repairing (describe):_-______- _______-_-__ -------------------------------- ------ - ----- -•- --- ----------------------------------------------------------------- -------------------------•--------------------------------------•--------------- 1 hereby certify that dhr rules pared this application theandJ°aquinthat hL°calkHealthleDistnc}n accordance with San Joaquin County ordinaZ7ws, a(Signe ! - --------------------------------------------------- wner an r Contract------- •---•----------- ------ Tale --- - - --- - - BY:------------------------•------------------------------------- - - (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTM NT USE NLY ACCEPTED BY-""-- r- r - DATE---- - ----- -- --- ---� ---------------- REVIEWED BY------------------------------------- --------------------------------------- - ------------------------------ ---- ---. DATE--------------------•-------------------------------------- APPLICATIONd or recommendations: - -------- DATE. BUILDING PERMIT ISSUED_-------------------------------------------- f f Alterat' ns an - ®�` I "-__-- -! ----------------- -------,'>'f r ,� _ 1 � f F.T ----- ------ __._- /d e�t;�- __ - ` ---------------------- �---- .FiNAL INSPECTI&q--BY:,-----------------•----------- -------- ------------------- _ .�•� � - ''~) SAN JOAQUIN LO AL HEALTH DISTRICT �. 132 Sycamore Street 814 North $ireet 130 South American Str t 300 West Oak Street y'Trac Ca,+farnia � Lodi, California Manteca, California ""�,_ Stockton, Ca1�F++ia 4Esifs k5 Frooll ES-9-2M 10-52 Revised W-2100