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4�iby APPLICATIONS FORSANITATION PERMIT Permit No. ._...p_.4.54.. (Complete in Duplicate) Date Issued Applade to the San Joaquin Local Health District for a permit to constru the wor herein describe . This application is made in compliance with County Ordinance No. 549. / Z4_ JOB ADDRESS AND LOCATION_.__-__) 1- 1 =©X- p.�7._- --J'" ......tl - Owner's Name------W_ , -_ ---- �._.--- - --- - - ---------------- ----- -------------------------------------- Phone.................................... Address ----- - 1-- ---I ...... a� ------ --•-----••--•--•-•-••-•----------•---•••-•--•---•----•--------•-•--- Contractor's Name-----�-W_ ........-- ----------------------------- Phone...... Installation will serve: Residence 1K Apartment House ❑ Commercial 171T43iler Court E] Motel ❑ Other ❑ Number of living units: --- Number of bedrooms Number of baths _ ___. Lot size ..............�- - Water Supply: Public system ❑ Community system ❑ Private x Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam) Clay ❑ Adobe 2r Hardpeti ] �. Previous Application Made: Yes ❑ No New Construction: Yes 5 No ❑ v�� _..._� TYPE OF INSTALLATION AND SPECIFICATIONS: - (No septic tank or cesspool permitted if public sewer is available within 200 feet.) , ' + 1 �: ' Septic Tank: Distance from nearest well ��----Distance fhm�foundation-----�-Q---......Materiaf'�__ .,I��,1 -� � No. of compartments-------*. ------. .-_-_ .--Liquid depth ._._%-_----- ----Capacity.- p sal Field: Distance from nearps� well-,/"-__._Dista ko fo ndation...__�.Q. C-91 --___-Distance to nearest lot.line ...........Disposal Number of lines__- r Lengee6c "Width of trench.__ �l Type of filter material ,__ filter ma T al len th_ -= •-- Seepage,`Pit: Distance to nearest well-- 57 ___.__Distance fr m foun a ione� t o nearest lot line__- 5 Number of pits._______________Lining material_ Size: Dlametei__ n De th ._ Cesspool: Distance from nearest well ________________Distance from�tou dation---------------------Linind�aterial- Size:,Diameter------------------ •-----Depth---------------------------------------------" ----Liquid Capacity.. _.. als. Privy: Distance from nearest well ___ ___ ___________________________ _Distance from nearest buildin ❑ Distance to nearest lot line ___-_________. _ g Remodeling and/or repairing (describe):-------1'1• ,r'_0_.p-74� ,� � ------ -------- ------� J..__... --•----•----------•------------•-•-•--------------••----•---•------------••----------•-•------------------ --------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, A fae law , a d rules and r6guIatig4,kvkfhe San Joaquin Local Health District. t (Signed)----•-- ---------- ---- ------------------- ---`�`=---- ----- 4_ .W,0.--- -•-------(Owner and/or Contractor) By:----------------------------------- --------------------------•-•--------------------------------------------- -- -- -------------------------------- -------------------Tale (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---- .. --.. REVIEWED BY DATE BUILDING PERMIT ISSUED............................... .................. - �---------------------------------------------------- DATE---------------- ti�" .• .. Alterations errcf/or recommendations______ 7 k a"v l.d - --------r ....... .... ---....._ _ .. -------------------- --------- - --- - ------------------------------------------------------------- .4Z.-- 4_9:NSPECTION — C?_u t�Jc�-Rp_.._1�iStd , �`'/ lw :..�C?. --7-2 ' ............... BY---------- --- Date...... S - _ ----- 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 ,5-/3- 51 tilf 60fa4P -13 rr )Zr 1-b 7Z aS' ES-9-2M 10-52 Revised W-2100 ��