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APPLICATION - — -- FOR SANITATION PERMIT P Ja ermit / No. 1 6 ~i (Complete in Duplicate) / Application is Date Issued / a P hereby made to the San Joaquin Local Health District This application is made in compliance with County Ordinance No. 549. // ict for a permit to construct and install the work herein described. JOB ADDRESS AND LOCATION_._7 4 q So. /;)1 ----------------------------------------------- --- ------------ Owner's �(J Owner's Name------ -Ti ____Ch C %Y ----------- I^ 1Q. Address-------- ;, -------------------------------------------------------------------- Phone__------------ ------------------ '- -------- -- Contractor's Name--------QIi(/ ----------------------------•--------------------------- Installation will serve: Residence ----------------------- ------------- Phone Apartment House -- •---- Number of living units: ___1____ Number of bedrooms - Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Water Supply: � Number of baths ---.� �j / ' pp y: Public system (K Community system Lot size ------ __ _X"��,j Character of soil to a depth of 3 feet: Sand Private ❑ Depth to Water Table ________ ft. Previous Application Made: Yes ❑ Gravel ❑ Sandy Loam ❑ Clay Loam New ❑ Clay ❑ Adobe Hardpan ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No Yes No ❑ (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well_'hQh�2._Distance from foundation___--------------- 0-"- No. of compartments_-._ Z_ ----"-M terial_____N"-Lv0o s�ze._ •x 5_X,3_ f, Liquid depth----_`�_.[ __-- Q _ Disposal Field: Distance from nearest well_ pYt�pistance from foundation_________ _ Capacity____ �1 (-- - Num�ier of lines_____________)..--__"_ - Z,��----"_-Distance to nearest lot lin _ Type ---___-_Length of each line 6-0-!_ Width of trench.__Z- "-rg" O„_____ yp br filter material- �ec_�-___-_"Depth of filter material____J_S��_ Seepage Pit: Distance to nearest well_.____-____ "_ ------Total length_._._____"_�Q Distance from foundation Seepage to nearest lot line _ Number of pits-----------------"_---Lining material___--Cesspool: --_..Size: Diameter__-_.___ ❑P Distance from nearest well---- __________Distance from foundation---------- materDiapth_-_ --'-___ Size: Diameter.___. -- Depth • Priv ------Liquid Capacity------------------ ---- is . y' Distance from nearest well-__-_--__._____ __ _ y -".__._;gals. ---------"___.____Distance from nearest building. Distance to nearest lot line-----------------------------••--------------------------------------._ 171 ------------------------- Remodeling and/or repaiFing (describe): - - ------------ - -----------------------------------------•---- hereby certify that I have prepared this application and that the work will bed ----------------------------------------- ordinances, ate laws, and rules and regulations of the San Joaquin Local Health District. one in accordance with San Joaquin County (Signed)__ C r By:------------------- (Owner and/or Contrator) r; ----- Plot plan, showing size of)m -------------------- t, location of system in relation to wells, buildings, etc., can be laced on (Title) P reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED B�Y__ f �, REVIEWED BY--------------------------------------------- "- f-- ----- ----- - --- -- t-- -- =----------------------- DATE-----f-�- --� -+�_ BUILDING PERMIT ISSUED ------------ ------ DATE ----------------------------------- ----------- - -- ----------------- ATE------- Alterations and/or recommendations:_____ �.! -r _ _.. , -• 1° = - ------------------------------------ - --------------------------------------------- FINAL INSPECTION BY:._ t ----------- Date- / ate - 130 South American S+ree+ SAN JOAQUIN LOCAL HEALTH DISTRICT 300 Wes+ Oak Street Stockton, California 132 Sycamore S+reet Lodi, California Manteca, California 814 North "C" Street ES-9-2M 10-52 Revised W-2100 Tracy, California