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FOR OFFIC S : ' 1,7 'APPLICATION _FOR SANITATION PERMIT Permit No. ----------- ---- /� i .(Complete in Duplicate) " ` - ____ __ This_Permit Expires 1 Year From Date Issued Application 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. 549 I I . �J JOB ADDRESS AND L ATION- CAM& Owner's NAipey� � 5---- S .�1. __ Address. QI`------- --� 7� q -------- __------ - _. ._.., Contractor's Name-------------------•------- ---�Rue 1 -55--x`' �/-�-C.�� ------------•-- Phone _ �- Installation will serve: Residence ❑ .Apartment House ❑ Commercial E1- Trailer Court ❑ Motel ❑ Other 0 CZU6- Number of living units: Number of bedrooms _,....r. Number of baths �...d. Lot size '------_-------- Water Supply: Public"system Community system ❑ }private ❑ Depth to Water Table 4 ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam Clay ❑ Adobe [3 Hardpan E] Previous;Application Made: {If yesdate__ ____-------------1 No "' New Construction: Yes No ❑ FHA/VA- Yes 0 N61K TYPE OF INSTALLATION AND SPECIFICATIONS: \ i { erect well�QlV.�___Dis#ante from foundatio0 feet. �•�""'L` '�" .. Septic Tank: Distance from nearest .� No septic +an ,or,cesspoo permitted i public sewer is available wtt to «� f/ L. IF No. of compartments_-----------------Size .--;Z'�A!--------.__�iquid depth_�e 7_:.__---------CapacityAW. -��_i Disposal Field: Distance from neares well._IvN_�°�''Distance from foundation _Q _-_ _-_--Distance to nearest of lina:�r _..... Number of lines____:_ - _--____ ._"____Len' th' of•each line-, Width of trench_- -I/I _ �r --Fr Type of filter material____ .�e°K.___-___Depth of filter material___-I- -------------Total length'___9-e--4 ------------------------ C� . ...,, �''�l A • See a e Pit: Distance-to nearest well'- - .aj '__-_Distance rom f undation_AZ.._.:__.Dista ce to nearest I t line�_--_-__ �- �g Number of pits-_ '_____'-____Lining material._KQ��____-Size; Diameter----4b.'__- Depth Cesspool: Distance from neare_st�well'-____---:.___Distance from foundation_-------------------Lining material--------.--.-_-____________________._. Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity---------------------------gals. Privy: Distance from nearest well__________ _____________________________________Distance from nearest building--__-_--_____-_______________-.__.-_-.-.-. Distance to nearest lot line-------- ---------------------------------------------------------------- -- --------------------------- ------ - - -- - - --------- - -- ----------- ------ -------------------- -- t w f ; -- �� -------------------- --- - ------------- ----------------------------•----- •-------------------•-•------------------I--•----------------------- I hereby certify that 1-have prPe9culatonsp*fhe this aplication and that +he work will be done in accordance with San Joaquin County ordinances, State laws, and rules a San quip Local Health District, d (Signed) L , r ____._____-. Owner and/or Contractor ` 9 )-------=----------------- -- _ f / ) --- ----- ---- $Y: � {Title)------- - �-�------------_-_--------- (Plot plan, showing size of lot, ocation of system in rely+ion to wells; buildings, etc., can be placecf on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED SY - --------------- DATE------ =1 ------------------------ ».. ,., ...: . .. A. , . REVIEWED BY r ---- ------ ------ ----- DATE = BUILDING"PERMIT ISSUED------------'--------------------------------= - ----------- ----••---------------------------- DATE-------------------------------------------------------------- Alterationsand/or recomirtendations-------------------------------------------------------------------------------- ------•---------..._._...-.----------------. --------------------------- -- ----- e------------------- ------------ -------------- r G - ------------- ----- � - - y- __________ ._--. --- o _ r_Gf- 1 ---------- 4_1 ,--- `— ------ "Z__....--��-----=� h r FINAL INSPECTION BY:.----- Date ----------- --- ---- -- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th street Stockton,California Lodi,California Manteca,California Tracy,California EB•9 REVIBEa B•51 r.P.ca.7M a-Go