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J r 27 APPLICATION FOR SANITATION PERMIT Permit No. .-L6�� tb �\ -7-4 (Complete in Duplicate) Date Issued N ly Application is here y 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. A r � --------------------------•--------•---•------------------------------- ON.� Phone-------"' ------------------------ JOB ADDRESS 6ND LOC -------------------- Owner's Name---*- j--- ---- F Li •--------------- ••---------•--• ----------------------- Address----------- - - --------------- Phone----------------------------------- Contractor's Name--- ---- -- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ M=t9�❑ cher ❑ Number of living units: -1----- Number of bedrooms _-_I___ Number of baths __._____ Lot si-zef}.------------f. - Water Supply: Public system [v1Community"system [I Private E] Depth to Water Table . ` Sand LClay Loam ElClay ❑ Adobe�ardpan ❑ Character of soil to a depth of 3 feet: Sand Gravel El Sandy 1 Previous Application Made: Yes ❑ No New Construction: Yes No ❑ I � TYPE OF INSTALLATION AND SPEC?FICATIONS- n -i (No septic tank or cesspool permitted if public sewer is available within 200 feet!) I - 01 Septic .ank: Distance from nearest well ista ce fro fours ation_ -- --- Ca pa No. of compartments_------- ---- ----- ize_ _.x X Liquid depth _. P Y t �. _._Distance from foundation-/V--y-W----- stance to nearest lot line_ __ Dispos Field: Distance from nearest e!I_._ J. _"Vdidth of tre ---------- --' __ �Number of lines__._ ___ .._ _ Length of each line________J. ___ ft; Type of filter materiefl -" .---_Depth of filter materia!-______�_. Tota! length `" --_____Distance from foundationDistance to nearest lot line___:._-"__.____ Seepage Pit: Distance to nearest well .___--_____ ._ - ❑ Number of pits------------- ------Lining material-----------------------Size: Diameter------------- Depth. Cesspool: Distance from nearest well----------------- from foundation---------------------Lining materiaL_-_________-________-"____-------- V ❑ r , `e!I______.___-------------------- - ----_-"--- Liquid Capacity ---------gals. Size: Diameter. "------------ De th - Distance from nearest building------------------------------------------ Privy: ----------------------- --------- -----Privy: Distance from nearest ❑ ----------------------------------- ------------------ Distance to nearest lot ine_______------------ --------------------------------------------------------------------- Remodeling and/or repairing (describe):---- i----------------------------------------------------------•-------------------,---------------------------------- ------"-----• -------------------------------------------------------------- ------------------------------------ - -- ---- --- -- --- ----- ------- - I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regu ations of the San Joaquin Local Health District. (Sign -------------------------------------------------(Owner and/or Contractor) ---------- By - -------------------------------------------------------------- ----- (Title) ---------------------------------------------------------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY DATE ----------------- - ---------- - ----------- APPLICATION ACCEPTED i3 - DATE V�----------- REVIEWED BY------------------------- - -- -------- __ DATE--------- --- - --------•- --- ------------- BUILDING PERMIT ISSUED y{ � �,- jb. //�//�`` . ------------ -- ---`----•-•--- L ---•------- S. - 1�-'---'-`� Altera#iondor recomrr}endati __..______ _ j. r ------------ ---"-------- ---------------•--- -----------------•------ - _ " 4 � f � , � ---------" -------- _ F_ _ _ • 1 FINAL INSPECTION BY---------------------------------------------- Date----------------------------------------------------- -------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 300 West Oak Street 132 Sycamore Street 814 North "C" Street 130 South American Street Trac California Stockton, California Lodi, California Manteea, California Y� ES-9-2M 10-52 Revised W-2100