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:t �( APPLICATION FOR SANITATION PERMIT Permit No. �_�_ (Complete in Duplicate) pate Issued . � ig- I Loca! Health District for a permit to construct and install the work herein described. Application is hereby made to the San Joaquin This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOC TIOND_3. _, FG '�-�'�' Owner's Name---- ---- ��----------------------------------------------- ------------ Phone------------------------------------ Address------------ ¢__� -------------- - •--------::---------------------------------------------------- � - U Contractor's Name C�+ijjwl- - 4 ---------------------------- Phone. -4727 Installation will serve: Residence 5 ] Apartment House [ICommercial ❑ Trailer Court [IMotel E] Other ❑ Number of living units: ----I_ Number of bedrooms __3_- Number of baths J----- Lot size --__]rs3 -1_v�6________________________ Water Supply: Public system W Community system ❑ Private ❑ Depth to Water Table 94—ft. Character of soil to a.depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ® Hardpan p Previous Application Made: Yes ❑ No New.Construction: Yes K No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) r Septic Tank: Distance from. nearest welL__NB��._Distance from foundation___r�___.-______.Mate��aL-____��_`�'- ___L✓D_4 Size 3 tk ------Li Liquid de th 4 - CapacitY 6Q_ --- No, - No, of compartments_________I--- q p r � Disposal Fie4d: Distance from nearest well-_/V o /�Distance from foundation-:_/ ___--_____.Distance to nearest lot line-- _-_-______.- Number of lines--------------- ----------------Length of each line--------- 'S-----------.Width of trench-----------ZS'�'---------.-- Type of filter material-___�o-G ------Depth of filter material----/-8_h__-_-____Total length___ _____/_-s3 ------ -- P'/1 P . t t: Distance to nearest well----1_Y_-e11A�---Distance from foundation--- to nearest lot line___--_..____.__. F Linin material_____'-- oC --.Size: Diameter---4%-7---.----Depth--------5�----------------- ® � Number of pits_,___-:.�.,.1- 9 �------ 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 \ Distanceto nearest lot Iine------------------------------------------- ------------------------------------------------------------------------- �y I Remodeling and/or repairing (describe):---------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------- ----------- F ----------------------•-----•--------------------------------------------------------------------------------------------------------- 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 regulations of the San Joaquin LocalIHealth District. GG IT Z-�_XI /1 3-12/`- rl ------------------- {Owner and/or Contractor) Signed �!C-P J------5. PITC(( } By----------------•------------Y - - �-------- - -- ------------- - ---------- -----(Title)--------G•1�1�-=Q..v ------------------ -------- (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 APPLICATION ACCEPTED BY.- 7AI ?'l - --- ---- DATE -+ =- - REVIEWEDBY-------------:---------- - --------------------------------------------- DATE - BUILDINGPERMIT ISSUED---------------------------- --------------------------- DATE------------------------------------------------------------- Alterations and/or recommendations---------------- ---- -----------•-----••------------------------------------------------ ----------------------------------------------------- FINAL INSPECTION BY:._------obu"l T 4_1---- Date----- J {Z ' ------------ ------ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street Soo West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9--2M Reviseo 1.57 F.P.M