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I;I APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) Date Issued AW51---- A, pplication 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. S49. 10B ADDRESS AND LOCATION - T'r------------- ��-- 0-y--:2 Owner's Name------------- p ----- Phone----------------------------------- Address--------------------- -----------------------Address--------------------- `f ------------------------------------ I� Contractor's Name------------ ---- --- ---------------------------------------------------------------------------- Phone-------- ---------- ----------- I,nstallation will serve: Residence 2j--7Gpartment House ❑ Commercial ❑ Trailer Court ❑ ' Motel ❑ Other ❑ �__ Number of baths _.� ,i�74- a67--------------------------------- ! Number of living units: ___.____ Number of bedrooms ___ tot size __ __ ' I � � Water Supply: Public system ❑ Community system ❑ Private ❑ Depth to Wafter Table ' v_7_'ft. IS of soil to a'depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ !IU previous Application Made: Yes ❑ No New Construction: Yes ❑ Na FHANA: Yes No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: i III (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) .1 s Septic Ta Distance from nearest well___---Distance from foundation.----✓ _.____ Material----- aterial--- �-�---�_ --------- 1111 _______ III � No. of compartments.------��------------- -Size_ _ ,'-4Q ---Liquid depth-------k ----------Capacity__/�Qe,'7---- Disposal F Distance from nearest well_._,_.__-_--Distance from foundation----Z�l_____-Distance to nearest lot line____v1��_�-_. �� Number of lines________iL -_ Length of each line___, i 1 ---------------Width of trench----- /r----------------- Type of filter material� _ � -___Depth of filter materia!____./�_____-____Total length____- , ` ---------------- Seepage P' Distance to nearest well -------_--_--Distance from foundation__AP�____-Distance to nearest lot line__----�_ Number of pits-------4Z----------Lining material___jeP4 E---Size: Diameter_ &`--_.____Depth----- _/.4M_- ,. esspool: Distance from nearest well________________Distance from foundation--------------------Lining material______-__________________________-- .� ❑ Size: Diameter - - -, - Depth- ----- - - --- - ---- ---------------Liquid Capacity - - ------ -gals. Privy- Distance from nearest well---------------------------------------------- from nearest building-------___.___._______________-__._____._. ❑ Distance to nearest lot line----------------------------------------------------------------------- ---------------------------------------------------------------------- TD �IRemodeling and/or repairing (describe):--------- ---4 •vIJ ...e1 =' 4w__ �----•-------------- •---•------------- ---------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ ;f�l ---------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------ � I I I I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County !Iordinances, State laws, and rules and regulations of the San Joaquin Local Health District. . (Signed)----------------- ' -------------�cwll�"Contractor) BY: :... +.- � �-------------------------------(Title)---- - /�f/1 -------------- ----------------- (Plot plan, showing size of lot, locationsystem in relation to wells, buildings, etc., can be placed on reverse side). .;p FOR DEPARTMENT USE ONLY III APPLICATION ACCEPTED BY------�_F� r-�- ----- - ----_- ------ DATE--------�"_-Z_�'_ REVIEWEDBY-------------- ----------------------------------------------------------------------------------------------------------- DATE------------•--- ----------------------------------------- BUILDING PERMIT ISSUED-------------------------------------------------- - DATE----------•---------- ------------------------------------- r,F � Alterations and/or recommendations--------------- -------- -------------------- ---------•---------------•---•------------------------•----------------------- --------------------------- �7----- ` itis--------0 --� --------15A -- - E--------��'- WL-- 7 R:5-P7---- ------- --------------- a � - � �� , -------------------------------------------------------------------------------------------------------------------------------------- ��------------------------------------------------ - - -- ------- ---- ---- -------------------------------------------------------------------------------------------------------------------- I -- -- ---------•--- - --- - - - -------------- ------------ - - 1 1 ... ------------------------------------------ FINAL fNSPE699t -BY.. sr Date ,..� rs}� I . j SAN JOAQUIN LOCAL HEALTH DISTRICT [30 South American Street 300 West Oek Street 132 Sycamore Sfreet 814 North "C" Street .w< Stockton, California Lodi, California Manteca, California Tracy, California x I ` ES-7-2M , Revised 1,57 F-P.CO-,