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\0IV APPLICATION FOR SANITATION PERMIT Permit No.Y'11) __ ----3- --- �cm (Complete in Duplicate) . Date Issued .__�I('J/S•-�-- Applica+ion is hereby made to the San Joaquin Local Health int ict for a permit to construct and install the work herein described. This application is made in compliance with County Ordina e N . 549. JOB ADDRESS fWD_LO- O ------- ----------------------------------------------------- ----- ---- ------ - - em ---- ------- Phone------------------------------- Owner's Name------� ---- --------------------------------------------- Address------------------- _/L'' --------------=f- �- r----- �' ' ----- Phon � (P ne Contractor's Name__.___ �-G,� �-�-----�-- -------------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __/__ Number of bedrooms 3._ Number of baths _/---- Lot size ____ _ _ Water Supply: Public system ❑ Community system ❑ Private Depth to Water-Table �_w ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 3---Hardpan ❑ Previous Application Made: Yes ❑ Noy gj-�N ew Construction: Yes ❑ No [A_� TYP F INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 240 feet.) psi Distance from nearest well----- _________Distance from foundation_____-_- --------Material_______________________________________-___-_. No. of compartments--------------------------Size---------------------------- Liquid depth Capacity----------------------- i osal eld: Distance from neare t wells'o--.---Distance from foundation �`�_. Di an nearest lot line__ --- ---- Number of lines----- ----- -- -- ----- - ----Length of each line_ - ------------Width of trench.__ _y -_-------------.- Type of filter material- -Depth of filter material_-__,�1-��- ____Total length_____c5V__/______________^_/__ Seepage Pit: Distance to nearest well___r_��^_---_____--Distanc o foundation _:___.Di�-ati�e to nearest lot line`--14--------- 1/ Number of pits--- ---.--------------Lining maternal- ---- --.Size: Diameter_ ------++-------Depth_..._/A_ --------------- Cesspool: Distance from nearest well-----------------Distance from foundation-----.--------------Lining material-__.____.-.__--.-____________.___-._. ❑ Size: Diameter----------- -------------------------Dept h_ --------------------------------------------------Liquid Capacity----------------------------gals. �1 Privy: Distance from nearest well-------------------------------------------------Distance from nearest building__-__________._---__________---.-.----.-- ❑ Distance to nearest lot line---------------------- ------ -------- ---- ---•--------------- - --------------------------------------------------- ------------------------- �t - Remodeling and/or repairing (describe):------------------------------------------------------------------------------------------------------------------------------------------------------- -------------------------------------------------------------- ------------------------------------------------------------ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County k� ordinances, State laws, and ruI s d;,r ulations of the San Jo uin Local alth District. (Signe Septic Tants l..f d_2 r a ----- -- -- - - ------------------------- - ---- -{Owner and/or Contractor) - = 1206 So.tcldaradia" k� '? :�_ {Title) �' Staon cartf!--------------------------------- - (Plot plan, sowing size of lot, location of system in relation wells, buildings, c., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY---- ------------------------- ----------------------------------------------------- DATE--------------- �5 ------------------------------ REVIEWED BY--------------------------------- - •-------- DATE--------------\--�------- --------------------------- _____________________________________ ____ __ J i BUILDINGPERMIT ISSUED-------------------------------- ----------------------------- DATE .:--------------------------•--------------------- Alterations and/or recommendations:--.----------- -------------------------------------------------------------------•-------•--------------------------------------------- / 5 No V!------ arLi4- ------J2,:=AD;u-_------------ -------- 1 - �r1 FINAL INSPECTION BY:..- "{G-L�1t'� Date--- �.J / '� ( �` I------------------------ S AN- IOAQUIN LOCAL HEALTH DISTRIC 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California cc 0.--30 Re„P..A W_91nn