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64, ✓ APPLICATION FOR SANITATION PERMIT Permit No.Lo (Complete in Duplicate) b'L� Date Issued Application is hereby 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. n JOB ADDRESS AND LOCATION:._-- •----- --3 � .. %�!►+�-'_____-- =- _ -- -•-- Owner's Name-------, - � "j"'�'t� - -- - -- Phone 1 Address r� I`�'' 7� ------- -- - Contractor's Name----•----M !Irs� �-..----------------------------------------------------------- --- ------------------------------ Phone ------ ----------------- Installation - -------------_Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑' Other Number of living units: ___le Number of bedrooms -4- Number of baths .?►-__ Lot size s7_x.1-'A--------------------------------- Water ____________________ ________Water Supply: Public system [)d Community system C, Private ❑ Depth to Water Table _T-__ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam [:] Clay Loam ❑ Clay ❑ Adobe'} Hardpan❑ Previous Application Made: Yes ❑ No I 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: F Distance from nearest well?^ -__Distance from foundation 1 I_ -- Material_ a+`J No, of compartments___:___- "_____-___Sizer` �X. __Liquid depth___-3__Y'b -------Capacity. ---Disposal Field:. Distance from nearest well _)t4'►'&4 Distance from foundation V ___.....Distance to nearest lot line,, rul Number of Tines____,' _---------------------------Length of each line__S_� is 4 Width of trenchOIAJ � ' Type of filter material_t ____-__ Depth of filter material_ _____Total length____: __________________ + � Seepage Pit: Distance to nearest well_ LS,.,___Distance from foundation ��__�______. i to ce to nearest lot line �� N Number of pits-----� _-___--__ Lining material__________________---Size: Diameter______ ______ ___Depth _ ___________ N _.___ Cesspool: Distance from nearest well-----------------Distance from foundation_ ______ ______Lining material__ -____----------_-------------- 1_71 ___ _-__.._____________❑ Size: Diameter--------------------------------------Depth-------------------------------------------- ----Liquid Capacity -- -_-- --•---------gals. Privy: Distance from nearest well________ .'_______.____-_________________Distance from nearest building------------------------------------------ El ______ ____-____ __________-______- ❑ Distance to nearest lot line----------------------- ------------------------------------- ------------------------- ------- ---- -------- --- Remodeling and/or repairing (describe)------ -------- ----------------------------------------------------------------------------------- -------- ------ ................ ----------------------------------------------------------------------•-------------- ----------------• ------------------------------------------------------------------................. ......----------- 4 - _______________________-_..____________................................................(.------------------------------------------------------------------------------------------------------------------------------------ ---------------------------------------------------------------------------------------JI �. 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 Local Health District. (Signed) 7?1C'.'_._ _____________________ 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 APPLICATION ACCEPTED BY ________________ DATE REVIEWED . Y DATE ,, BUILDJNG.PERMIT ISSUED............... ____ ____t -___- DATE_DATE-4,4-- REVIEWED ;;i 52 R r t F -- Alteratio sand or recom ends 4 __ f � ..... _ N ----------------------------------- ----------------------...... ._.............•- ----- ------- ------------------------------------------_1 _------ ----- ---------------- ----------_------------- FINAL INSPECTIONBY:.. F °2' ?' --- ---__ Date----- . SAN JOAQ IN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Str at 132 Sycamore Street 814North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M 8-51 Revised W-2100 '