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2_3 `11'2-- v:0 APPLICATION FOR SANITATION PERMIT Permit No. ... /�-.ySl (Complete in Duplicate) _ Date Issued J;1_7-7154. ---- 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. JOB ADDRESS AND LOCATION_-t--------1-55---69----------5-`----0rp---------------------------------------- -- Owner's Name------------------------ -_ ---------------------------------------------------------- ----- ------- --- Phone- - - 0 Address =--------------- --------- -=-----OY- -------- - L?-`---- rC o ry Contractor's Name----------R-0( D---- ----- -- ----------------------- Phone... Installation will serve: Residence parfme,nf House ❑ Commercial ❑ Trailer Court ❑ Motel Other ❑ dde Number of living units: _�___ N tuber of bedrooms _ Number of baths 1--_ Lot size _- e - X--- -___---------_ i Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table 3(Q- ft. Character of soil to a depth of 3 feet: Sand�N,, ravel ❑ Sandy Loam ❑ Clay`Loam E] Clay ❑ Adobe HardpanElPrevious Application Made: Yes E] No Construction: Yes ❑ No EO/ HA/VA: Yes ❑ No [ _ TYPE OF INSTALLATION AND SPECIFICATIONS: , (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) Septic yan : Distance from nearest well ------ Distance from foundation___ -..Material-------------------------------------.------------ N'0. _----:-.--.No. of compartments = Size Liquid depth --------------Capacity---•------------------- isp sal Fi istance from nearest well_________________Distance from foundation--------------------Distance to nearest lot line_---_--._-----.._ [ ( Number of lines---I-------------------------------Length of each line-,-------------------------...Width of french----------------------------------- T Type of filter material-------------------------Depth of filter material --------_----.------'Total length-------------------- _-----__---- Seepage Distance to nearest well____11_274----Distance from foundation_._. �} � � �r �•�..--....Dista fce to nearest lot Number of pits.--- ------- ming material---I_ --Jtl4tSe -Diameter---- ---.--.----Depth-.- -r-•-•------------ Cesspool: Distance fi,om nearest well------- --------Distance from foundation--------------------Lining maferiaf--------------------------- 0 Size: Diameter----.-l------------------ ------------Depth----------------------------------------------------Liquid Capacity---------------------------- gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building--.---.----------'___---___---.--.----.-. ❑ Distance to nearest lot line--------------------------------------------------------------------------------------•----------------------------------------------------•-- , r - r. Remodeling and/o . epairin ,(des }:-- - - ------------------- -----------------------------------------•-------------•--------------------------------------------- ---------------- ---- --1------------ --------------------------------------------------------------------- --------------------------------------•----------------------------------------------------------------------• ----------------------------------- ---- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules andira ulations of the S n Joaquin focal Health District. (Signed)---------------- fir={�------------ --- 7/�j "GL r ----------------------(Owner and/or Contractor} By------------- .......................... ----- o. - - ------------------------------•---•------------(Title)--------------------------------------------- - ------------ ---- - - (Plot plan, showing size of lot, Iocatio f system in relation to wells, buildings, etc., can be placed on reverse side). r FOR DEPARTMENT USE ONLY REVIEWED BY :---- ---- - ------ ------------------- DATE -------- APPLICATION ACCEPTED BY--_-------------------- - DATE-------------- �']t ' - " � f------------------------ BUILDING PERMIT PERMIT ISSUED-----------------�----- -- ---- ----------------------------- ----------------------------------- DATE------------------- and/or recoMmendations:--`------ -- ------------------------------------------------------------------ ----------------- �. -••-------•-------....._-------- 7 r - - - 1 - -- --- ------ ---- -----°� 1 j ' . -2 ? - - " FINAL INSPECTION BY. 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 ES-9-2iv1 ,' Revised 1.57 F.P.CO.