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' Permit No. Lo-3_ASO O APPLICATION FOR SANITATION PERMIT - - -- - �, (Complete in D plicate) Date Issued tf,�' ( l'yt- j'Y 1717L SHA 4* 4 c/- s3 719-6 Application is hereby made to the San Joaquin Local Health District for a permit to constr n�l�install the work h en�lescribedl This application is made in compliance with County CI��i n No. 549. ` ` # ""l�` `j"/ JOB ADDRESS AND LOCATION/, Ar ------ ----- Owner's Name--------C IT2 ¢ lY-------- - ---- - �' -------------------- Phone------------------------------------ ---p--, �- ° - Address-------------_-- --------------------------------------------------------------------------------------- Contractor's Name---------------- -------F/-�.�1 �' ----g_j�"'"-`------------------------------------------------------ Phone�W.1'37X0 Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ /Other [3Number of living units: __/ Number of bedrooms _s __ Number of baths ._/__ Lot size ------ � f--lr-.r�--- Water Supply: Public system ❑ Community system 59"I"rivate ❑ Depth to Water Table y ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe a--Inardpan ❑ Previous Application Made: Yes ❑ No New Construction: Yes R"'Nio ❑ FHA/VA: Yes R?O"No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted iff blic sewer is available within 200 feet.) Septic T nk: Distance from nearest well !•'___Distance from foundation.-. 4-". MateialZ ------. �r - No. of compartments__.____o ------------ SizeJ76 ?-______._Capacity---- - -�------ -_ X4--- __ i uid de th___-- Q- Disposal ield: Distance from nearest wef?2#* 4V_Distance from foundation--/4_l..__.._..Distance to nearest lot line_____________� Number of lines.-______-A---------------------Length of each line_.�_Q___P_. __.Width of trench___. :y Type of filter matitrial__- Depth of filter material-__--11----------Total length-------ASS"o_--__________________ Seepage t: Distance to nearest well_d'>'"&-------Distanc9,'jom oundation...le_........Distance to nearest lot line_____�i- Number of pits-__-a-__--____Lining material-_- -----Size: Diameter-___,?.3_ _..._Depth------c22-Q -------------- 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------------------------------.__---__-._. ❑ Distance to nearest lot 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 ordinances, Sta ws, and rules P61 regulations of the San aquin Local Health District. ---- (Owner and/or Contractor) (Signed) �'�`" s' Q B ' --------------------------------------------'� ------- (Title) Y•-- (Plot plan, showing size of lot, location of system in relation wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY ------------------------------------------------------------------------------------------ DATE-- --R REVIEVhDBY------- DATE--�------------------------------------------------ BUILDING PERMIT ISSUED---=----------- -------------------------- ------ DATE-------- tfi---- ------------------------------------------ Alterations and/or ec me tions: ------------------------------------------------------•--•---------•-----•--- F s --------. _ . �-- ---- -4-------------> >��_� .��t -----------A- ---- ---------- --------- ------------t- ---- --- - ----- ------- ------------ - r�/ 1 �- ----------------------------------------- FINAL INSPECTION BY------I_- 7, �--------------------- Date---- --------------- - SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M - Revised 1.57 F.P.CO.