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-:— J� APPLICATION FOR SANITATION PEZPli Permit No../.D_l--f " V (Complete in Dupllcafe) Date Issued Application is hereby made to the San Joaquin Local Health District for a permitto onstruct and install the work herein described. This application is made in. compliance with County Ordinance No. 549. r .. JOB ADDRESS AND LOCATION---------------,-,.Z---S Owner's Name_ - j-j-e_�''t5' '"}-.�-------------- Phone. Address--------------------•---- ' { Contractor's Name' = ° + ------------------ ----------- Phone ' Installation will will serve: Residence j Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other Number of living units: -----!--,Number .of bedrooms ---- I--- Number of baths ___I___ Lot size -------- 57Q. l5Q _ Water Supply: Public system Z Communitysystem �' �# y ❑ Private ❑ Depth to Water Table ___ ft. A _ Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam I75 l .flay ❑ Adobe [r Hardpan ❑ }+i Previous Application Made: Yes ❑ No ❑ New Construction: Yes ❑ No-ED TYPE OF INSTALLATION AND SPECIFICATIONS:j, I (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well_________________ Distance from foundation -------------------- Material__._________- No. of compartments------------------------ Size -------•----------- ----------= _.__ ------------------------------ - Liquid depth---------------------_- Capacity -.. Disposal Field: Disfance from nearest well ------------------ Distance from foundation_.Distance to nearest lot line ----------------- EI Number of lines----------------------------------- Length of each line -------------_ ---- ----------.Width of trench------------------------------ Type of filter material ----------- Depth of filter material--_._____------------- Total length ---------------- _.___________ _ ----------- Seepage Pit: Distance to nearest well_____________________Distance from foundation ------------------- .Distance to nearest lot line__________.__.._ ❑ Number of pits-__------- ------Lining-material-----------------------Size: Diameter----_------------------ Depth------------------------------ Cesspool: Distance from nearest well ____-tr----Distance from founda tion______�Lining materia_____- ----__,--Si10�ze: Diameter �Gv ,�-------------------p--------------- - -------------------------- Liquid Capacity ---gals. Privy: Distance from nearest well ____-----,__----__11!N_1(----_- _ Distance to nearest lot line_._Distance from nearesr building ---------5---- ______ 1d_---____ _ Remodeling and/or repairing (describe): -------------------- . --ffi✓[------ aYr /27 '-'----------------------- --------•------------------- -----------------------------------------------------•--------------------------------- ----- -•---- ----- ---- ----------- - --------------------------------------------------------- 1I�t....1�j� GL `. r1--------Q_rz�% U i- --------------------------------------------------------------- -- hereb certify that I have ----------------------------------- Y y 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)------ ------------ ------------•----------------•---------------------------------------- ------ ----- --- -- ----------------(Owner and/or Contractor) BY:J'.a*�r!'-�`-"=._- _ (Title)-- _________ - ---------------------------------- (Plot plan, showing size of lot, location of system in rel tion to wells, buildings, efc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------------------------------------------------------------------ DATE f-r -�-- REVIEWED BY ------------------------------------------ ----- ��-- ---- -- --------------------- ------ ----- DATE---------------------------------------- BUILDING PERMIT ISSUED ------------------ _� ---------------------- 00------- �..__ DATE_ ! E.� Alte rafjons and/or recommendati ns:__ . __4-.------._mac-_ rye Q,�) r�.�- - -- -- �t------------- --- �{ --------•------------------------------------------------------------ ----- ------------------------------------------------------------------ FINAL INSPECTION BY:,. ------- ------------------- ------------- Date--------- ------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 -Sycamore Street 814 north "C" Sfree+ Stockton, California. Lodi, California Manteca, California Tracy. California ES-9-2M 10-52 Revised W-2100 {