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•- d '` APPLICATION FOR SANITATION PERMIT �p Permit No. ____.._f.......... (Complete in Duplicate) Date Issued •o i 1� Applica4-ion is hereby made to the San Joaquin Local Health District for a permit�to const install th Mkheres- described. This application is made in compliance with County Ordinance No. 549. 1 JOB ADDRESS AND LOCATION...... -� - ----�---- e, � --------------------------------------- -- --,----------------•-•-------------- ff Owner's Name----lis.�--L_{.L.�--C=-------�F��-�..5.-• •-------•-------------------------------------- ----------- ----------- ---------- one--- ------ � 9 .. ,.. Address------------ Contractor's Name----- o.h.------- ----� Y.__ --6--------------------------------------------------------------- Phone Installation will serve: Residence, Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __I____ Number of bedrooms .. — Number of baths ___r__ Lot size ____ _ _-_ ____ - ------------------- A1 Water Supply: lCity system [IPrivate ❑ Depth to Water Table ______- ft. PP Y: Pubic system� ommun4 Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ' Hardpan ❑ Previous Application Made: Yes ❑ NoNew Construction: Yes No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ----- :_.. a#erial_ _ V-� -_---------• . istance from foundation-lb- Septic Tank: Distance from nearest well__�_S- -�� No. of compartments- -----------------Size_--- � �i ---Liquid depth._�1.- ----------------Capacity.-2 4 Disposal Field: Distance from nearest well�_D�tDistance from foundation__ __..f...Distance to nearest lot line____�1�..__._.._ Number of lines---------- ------------ --------- gth of each line----_ -�- �� Width of trench_-- -- ----------:=- #h of filter material_._____ Total len tl,_____1____ C2-------------------- Type of filter material_-��C. / ,,- j - gT\ Seepage Pit: Distance to nearest well_______-----------_---Distance from foundation___-_______.._-__-.Distance to nearest lot line---------------- El Number of pits----------------------Lining material-----------------------Size: Diameter----------------- ---Depth--------------------------------- { Cesspool: Distance from nearest well_________________Distance from foundation--------------------Lining material__..__...._._____.__._________.-- -. Size: Diameter-----------------_---- Depth - ------------------------ _ n r ter- _ - _ �. ------- ----- -- -Li Ca acit _:. . - -_---- --gals. Liquid - Privy: distance from nearest well-------------------------------------------------Distance rom neares wilding:______________------.--__-._y_,•---- `�' Distance to nearest lot line---------------------------------- -- ----------------------------------t El Remodeling and/or repairing (describe):--- ---------- describe:- �F c e4`h, '---� ----- 0-- --------- ---------• -------------•---------. s ------------•----------•--••----------_----•-- ----------------------------------------- - - ---------------------- ----------- ------------••-•------------•----•-----------------•--------------------------------------•--------------------------------------------------------------- I hereby certify that I have prepared this application and that +he work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. i + t (Signed) - ----- F `-fes' (Owner and/or Con roc or) Tale (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 APPLICATIONACCEPTED BY-- ---------- ------ --- ------- ------ -- ------------------ ------ DATE--------------- --------- ----------------------------- REVIEWED BY---------------------------------- ---------- ---- - ---- DATE ------ -- __ DATE..---- ----- BUILDING'TERMIT ISSUED------------------------ ------- - -- -------_-----s-------------------••----- I erations aYad/or recommendations:---.-_-------- :._ _ ---------------------- ---------•--------- •---- ----- A�-.- ...... r - ------- --------------- ----------------------------- ---------------------------------- ------------- - --------------- v INAL iNSPECTi N 8Y: Date_ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California A ES-9-2M 145446 ATWOd❑ IZ-54 I y