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Q � y APPLICATION FOR SANITATION PERMIT 77Permi=No. .�2. (Complete in Duplicate) Ve V/ '✓ /[�''y.�� bate Issued Application is hereby made to the San Joaquin Local Health District fora permit to construct an nstall th ork her n descri . pp p y� Ordinance No. 549. Od baLo C,k on S . Anteros 1 - - - . This application is made m compliance with Count JOB ADDRESS AND LOCATION_-. @ _:o "_: , __ te_st---aide _on__&xiexo Owner's Nome------1'2rY' i er_---=- -•••-•• •---•-------- -- ------ Ph e---- --551 - ......... Address ------------•----Qnr_ner'.Xe.her--- ---A ----- - ----- --- ----- -------- -- __.... Contractor's Name-- ----- ----- -------------------- --------------------- Phone----� Installation will serve: `'Residences Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel❑ Other Number of Living units: __],._ Number of bedrooms _-2--_ Number of baths ---1_ Lot size ......5-OX10D-----------------------______________ Water Supply: Public system [2 Community system fl Private ❑ Depth to Water Table _Ii:O_ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam❑ Clay❑ Adobe E] Hardpan Previous Application Made: Yes ❑ No 2] New Construction: Yes ,[j 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-------- =__Distance from foundation.....$a..........Material------S.eZ.1e11i=br10_1;:-____-_ [.s No, of compartments-------- ________________Size...-_tx4f_X�¢.______Liquid depth:__ 51-&3.........Capacity.___a O0-:_______- Disposal Field: Distance from nearest well-------�-Q Distance-from foundation_____10t_____._Distance-to nearest lot line----------5.r _ 13 Number of lines__ ...1- Length of each line------------18r� Width of trench --s Type of filter material___. -._r" ?c ____Depth of filter material_ __________________Total length.............75 _____-:___________ Seepage Pit: Distance to nearest well_ _________ ______Distance from foundation._______-----------Distance to nearest lot Iine.................. Number of pits----__--------------Lining material---------------__----_-Size: Diameter-------------------------Depth---------------------- ------ Cesspool• Distance from nearest well_________________Distance from foundation------------------Lining material-__. , ___-- _____.___ -_-- ❑ Size: Diameter-__----------------------------------------Depth.................. __ _-_--------------Liquid Capacity gels Privy: Distance from nearest well-------------------------------------------------Distance from nearest building Distance to nearest lot line - -------------------- Remodeling and/or repairing,(describe):........il@S ----symte.:0.-------------------------------------------------------------------------------------- . ... •------------ ' -•-- ----• ----- ---- - ----- ---•--• ------• --------------------------------- ------ ------ ----- - •--- ------- ------- --- ------------- I hereby certify that-1 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. r (Signed) Da1;_aSet1_Q_.Tom.slerv_ _e-.......-----=---- ___Owner and/or Contractor Q f 4�I-'ar Z'. Perm 'Ta1��harz s:l -------- -------------- Ttk:_ By ( ) (Plot plan, showing $''ze 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-------------- - ...................................... Alterations and/or re mmendat ns -" - f -°`"� ----- 'FINAL I PECTION BY:......... -� �"` -- ---------------_-- 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 5-51 Revised W-2100