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.'" Permit Na. ._(�___�_`�_._... APPLICATION FOR SANITATION PERMIT (Complete in Duplicate) Date Issued /-7 7-- CPD--/I Applica*ion is hereby made to the San Joaquin Local Health District for a permit to construct and install the eL�wor4k-,,, des . T is application is made in com liance with County Ordinance No. 549. }� 3So 8. �GK '� .r,: -- ----------------------- ---------------- _ _ - e JOB AQDRE55 AND LOCAT{ON____- - -- Owner's Name---vwo ------- - 041 Phone ----------�- - ---=-- �- -. . _a T¢ ------------- ------------------------------------------ ----------- ------------------- Address_.---1.-76-S----------------` .. Contractor's Name---------- --' - -------------------------------------------------------------------------------------------------- --.-_- Phone�Q:y_�`,�`-t'-3� Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ { / ,✓�Q ,}� "� ----------------•------- Number of living units: _ ___- Number of bedrooms-5-- Number of baths --f---_ Lot size _-- __ -- Water Supply: Public system ❑ Community system ❑ Privatex Depth to Water Table ------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam X Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: Yes ❑ No 0 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__- r ____Distance from fo ndat - !_Q----_-._--.Material---x7 .-------------------- ---- iquid d fipth ---- - -� ----Capacity-------0 C� j� No. of compartments----- -----' -'--------Size--- - ----- X //!! f Disposal Field: Distance from nearest well---.5-.l�..._Distance from foundation--- - . Distance to nearest lot lineA- ------- Len th of each line----------60 Q-- Width of french-__-- �----------------- Number oflines--------------- -c------------- 9 r7 --------- Type of filter material----��,G-�----Depth of filter material__-.--�-y-_,_-.-_--Total length---_-_�- - ----------------------- Seepage -- ___----- 1 Seepage Pit: Distance to nearest well-----_---------------Distance from foundation--------------------Distance to nearest lot line----------------- ❑ Number of pits-------------- -------Lining material---------------------..Size: Diameter Depth U} Pi Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material---------------------- ---- els. ❑ Size: Diameter -----------.Depth----------------------------------------------------Liquid Capacity--------------------�- gl ,. Privy: Distance from nearest`vrell-------------------------------------------------Distance from nearest building----------------------------------------- ❑ Distance to nearest lot line---------------------------- -------------- \`'}\ `!�.'r""'� -----------•------------------------------------------------------ Remodeling and/or repairing (describe):-------------------------- ------- -------•---- - ----- -- - ------- --- --- - -------- - ----------- -------- -- ------- ------ I hereby certify the+ I have prepared this applica+ion and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules andjregulations of the San Joaquin Local Health District. r � ----------------------- (Signed) --------- ----- ----------------------------------(Own and/or Contractor) (Owner Title ��"4�� By:---------------------------•------------------------ - ---------- ----------------------------------------------- (Title) - s -- (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--------------------- --- ---------------------------------------------------- DATE �- --------- -- �J`- i f--�-------------- REVIEWED BY--------------------------------------------- ------ -- -- ---- --------- -----------------------------I- ------ DATE-----------# - BUILDING PERMIT 155UED---------- --------------- -- ---- ------------ --------------------------- ---------------------- DATE--------------------------------------•--------------------- Alterations and/or recommendations------------- ._-.._ ------I-------------------------------------------------------- -------------------------------- ------------------------------------ ---- --------------- ------------------------ ----•--------------- ------------------------------------------ - FINAL INSPECTION BY:, ------------------- --------------------- Dafie ----------------------------- -- ---------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 300 West Oak Street 132 sycamore Sfreet 814 North "C" Street 130 South American Street Tracy, California Stockton,'California Lodi, California Manteca, California Y. ES-4-2M Revised W-2100