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APPLICATION FOR SANITATION PERMIT (Complete in Duplicate) Permit No.1� 3 Date issued ..37�y�� Applica-ion is hereby made to the SanJoaquinLocal Health District for-a permit to construe and install the work h rein described. -descriri-beed. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATfON.__.___.---�Lj-�-��d_ Owner's Name_ --------------------------- - - )0-' /------ /�,�•, _-------- ---�u--S ------------------------------------ ---- Phone---------- ----- -----•------------------------------------- -------- v------- -----------•-----•------•-•---- = Contractor's Name__._ --------•------•--•-•• - _ -•---•�---�--�=!.�•S-- ` , ------ Phone__!`f'-d_.�a ��f Installation will serve: Residence [ Apartment House [❑ Commercial ❑ Trailer Court ❑ Motel [❑ Other ❑ Number of living units: _l___ Number of bedrooms -- Number of baths .% L of size -�� ----- Water Supply: Public system E] Community system P�,Private ❑ Depth to Water Table 'gip ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe R, Hardpan ❑ Previous Application Made: Yes ❑ No R New Construction: Yes No Ej TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) t Septic Tank: Disfance from nearest well--:W'r__ s Distance from foundation----�g-------- ,Material___--�_-e_-- .t No. of compartments____-49--------- 1 Sixe---- _7 ~41----Liquid depth......k_D./`-----.Capacity_ ___ Disposal Field: Distance from nearest well--__'Distance from foundation, (� .. _--.Distance to nearest lot line__..f.G•�- Number of lines----------- --- � -1----Width of trench------, - - r__-__------ _ _ _Length of each line-__________ - Type of filter material-_�. --a_ tr 5)12,--Depth of filter material------ -- ---------To#al length-------! - -- Y Seepage Pit: Distance to nearest waif....A{�JD-:`---Distance from ound'ati n__:_ �- Q D___-_--.Distance to nearesf lot line__,?'-a__-__ ® Number of Pits------/_____--____Lining maferial_ +rte' -- --- - -��Is�'ramefier------��.-----.Depfih_.��5- ------------------ ---------- Cesspool: Distance from nearest well____ _ -Dis#ance from foundation--------------------Lining material___-- Size: Diameter------ ------- - -- ----- ---------Depth-- Privy: Distance from nearest well-- -- --=---- --------------------------------------- g Liquid Capacity--- --------•----•---•------ ale. --------------------------------------------_Distance from nearest building 9 --------❑ Distance to nearest lot line -- ____ ___________ -- ------•----------------- Remodeling and/or repairing (describe)________________________ 1 .. I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Sta laws, and rules and regulations of the San Joaquin Local Health District. r _ — (Signed).......-------- - -------------------------------------------------•----------- -------(Owner and/or Contractor) BY: ------ Lr1 _ 1 Title__. - { I 2�:- n-------------------------------------- (Plot plan, showing size 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 --------------4'�---------------- REVIEWED BY------------------ -------- ---------- --------------�-�"��-----�- ------ -- -- .. -------••----- 8UlLD1NG PERMIT ISSUED ----------------------- �`r -- ------------------------------ DATE-----------`---=------- �>�4 --------------------------------------- DATE -°'1 Alterations and/or recommendations------------------------- - ---_- ----------------- --------------------------------- ---- _ --------------------------------- `- _ � -- ---------------------------- --•--------------------- 1 -----;.1_1 --=-------------------------------- -------------•----------- ----------------------------------------- ------ ----------------------------- -- - --------------------------------------- ------------ ---------- F - -- ----- --- -- F1NAL INSPECTION $Y: -elos--------------------- ---------•---- Date---:4�_. SAN JOAQUIN LOCAL HEALTH DISTRICT 130 Soufh American Street 300 West Oafs Street 132 Sycamore Sfree+ 8 f 4 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M 145446 ATwgoo 12-54 -