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>� tk1�d\ K I 1-4 " f`"�' G •l ° APPLICATION FOR SANITATIO§p� T Permit No. ._.�._.. .. 't" L `^-`4zot (Complete in Duplicate) Sp A f ? 9 � C, � I � Date Issued pp rca Ion Is er by 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 Ordinanc . 549., JOB ADDRESS AND LOCATION....pS.iP_ ------ .._ 2rvJ% ----------_-----�---J-- _- // / T T / A^ ---- --_---------------- Phonejl_�J..-.(O_^_�1e�..,' Owner's Name--------- '-- -�--"`--r ------�--/OJ_le.[:r-1��--------.....----'---------- --- Address.`- 1 Ol�_ F7[�.... Q11.1z!. r7`.. - - T O Contractor's Name �1J.t� IS17 - I/YC._.... -_--------------------------------- Phonei:.lL._'_!_�Q7 Installation will serve: Residence � Apartment House ❑ Commercial ❑ Trailer Court ❑//Motel ❑ Other ❑ Number of living units: ..f._.. Number of bedrooms.3_.. Number of baths--- Lot size ---Z*_67.K__L_3S..- Wafer Supply: Public system D9 Community system ❑ Private ❑ Depth to Water Table.5r. ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay p Adobe Hardpan ❑ Previous Application Made: Yes ❑ No % New Construction: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: � �+-fid-- -�-L.Y A (No septic tank or cesspool permitted if public sewer is available within 200 tae+,) Septic Tank: Distance from nearest well_W -CAIE'Distance, from, (foundation''j,1:..__.._.Maferial_ �1_lY(rilZ.E2"�.�..__._.._... 19 No. of compartments_._7�-- --------------Size. P__fIM7F_3 _._Liquiddepth...S.9._......____Capacity1",Q._Ttf Disposal Field: Distance from nearest well-------------- .Distance from foundation----------------_Distance to nearest lot line___-....__._. (v ❑ Number of lines_----------------------------- _Length of each line----------------------.-------Width of trench..._........:.......___.______ V Type of filter material---------------- -------Depth of filter material---.._------_ ------Total length......................_.._._..__..------ Seepage Pit: Distance to nearest well. (!ta(E...Distance from foundation_-/O..._._.__. line.-..'j !L e Dist ice to nearest lot ___________ l J i Number of pits.QA�-_...Lining material.8h'LL°L�._Size: Diameter._ ..__......Depth----- .._..._--....____ Cesspool: Distance from nearest well--- -------------Distance from foundation--------- --------- Lining material---__------------------------------ F] ...._..................._..❑ Size: Diameter-----------------_---------------Depth---------------------------. ..Liquid Capacity----------------------------gals. Privy: Distance from nearest well ------------ from nearest building-----------------------------_........... ❑ Distance t�rest lot line.......--�T—( - - � ------ ------ ..._-_ --- _------------------------------------------------ 2.!! --- ----------- ---- Remodeling and/or pairing (describe)= GxYL.-y-- --------- ----------- t.� 14- _ - - -...................-- ----- --- `�� tjf d - -----------------.------ -------------__.........--------------------------- ----__._.-----_____--------------------------------...__.._.._...___.___.___.._._.____..._.--..__._....._._._.._.._.__-- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State law ules and regulations of the San Joaquin Local Health District, (Signed) f{ K x 1 �/4.y __ _..- (Owner and/or Contractor) By:._ -. .. ...----- -------- a. .(Title) - (Plot plan, showing size of lot, location of system in relation td wells, buildings, etc., can be placn reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----------------------------------------------------- ------------------------ DATE--- --- _ ...... REVIEWED BY-------------------------------- - - ....._.. -- —tl ---- ...........------------------- DATE...---- - - -------------------------- ----- ------ ----- - BUILDINGPERMIT ISSUED-------------------------------------- ------------------------ ------------ DATE-------------- ------------------------------------ Alterations and/or recommendations;---- ------------------------------------------------------.....................................................-.....--------........................... .... -- F.... .-- - - a ----- -------- -------- - - - ----- -------------- ------ ------- ------ ---------------------------•------------------------------------------------------------------------------- ................. ----------------- -- .. .. . . . ---- .. .....-....__ ._._ ... .. _3 ..................... FINAL INSPECTION BY:.--------11.&44 zellm Date.... /_/rl.. -IS-----------._.....---...._.---------- Ilv// 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-9-21A Revised W-2100