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UUU t 46�LIATION FOR SANITATION 'PERMIT Perini+ I`10f __3 � 1 - 3- / (Complete in Duplicate) Date .Issued �_ '�' { U V Application is hereby made.to the San Joaquin Local Heai+h'District for a permit to construct and install the work herein described. This app' ioJn is maP i compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION-- t - -- --- ----------------------------------------- Owner's Name-------------- -- --n—ki - ------ ------=------------------------------------------------------------------- Phone--------- ---- .. •� '+ ��1 "!�m� -- ------------------------•------------------- Address------------- Contractor's Name_________________________ Phone-------------------------••------- Installation will serve: Residence ® Apartment.House ❑ Commercial ❑ Trailer Court [❑ Motel ❑ Other ❑ i Number of living units: ___!___ Number of bedrooms 3 _ Number of baths _�> -_- Lot size _-___- ��_____�__r�, Water Supply: Publics stems y Er Community system ❑ Private ® Depth to Water Table ________ ft. Character of soil to a depth of 3 feet Sand ❑ Gravel ❑ Sandy Loam 0 Clay Loam ❑ Clay ❑ Adobe 20 Hardpan Previous Application Made: Yes ❑ No .R] New Construction: Yes ❑ No ❑ TYPE OF.INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) . ��,.�i i Septic Tank: Distance from nearest well----_[��Sy_;---Distance,from foundation-----24---------Material �1' C r-__ -G ......... , -4. W__A � Na. of compartments----------A________---Si,,/JX_ _ _ ,.quid depth--____.��_ ____________Capacity_-,/D��_____ .r y Qr ' , Disposal Field: *Distance from neares# wea_..�__.__-___Distance from foundatior;___10 __-.__Distance to nearest lot GnetR_,��______ $} Number of lines___r______ _ Length of each line �/ 9 �l��-- -77 _ � Width of french-------_-- -= a l - > - Type of filter material__/��__'?M✓WDepth of filter material_____�g"_____--Total length_________ _ _ _______________ Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line_____--_-________ ❑ Number of pits----------------- _--Lining material-----------------------Size: Diameter-----------------------Depth--------------------------------- Cesspool: Distance from nearest well------------------Distance from foundation------------------- material-------.------------.________ ❑ Size: Diameter------------=-------------------------Depth----------------------------------------------------Li Liquid Capacity q ----------------------------gals. Privy: Distance from nearest well--------------------------------------------------Distance from nearest building-------------------------- _ ❑ Distance to nearest lot line - --------------- --------------------------------------------------- ^. -w+ - --- ----------- ------------ ------------------------------- -------------- ---------------------------------------------•----------------------------------------- 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 and regulations of the. San Joaquin Local Health District. (Signed} ------ ••--- '---- -------- ----------------------- ------------------------------- -------(Owner and/or Contractor) a By---------------------_-•--------------_-------------•-----•-------•-------•------------------------------•------------------------(Title)------------------------------- ------------------ ----------- a (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). F EPAR MENT ONLY APPLICATION ACCEPTED BY-- y DATE $72-2-7- ` ' REVIEWED BY. -------------------------------- ------------- - - DATE -- -- -- ---------------------------------------------------- BUILDING PERMIT ISSUED--------------------'- = '= DATE-. --- -------------------------------- Alterations and/or and/or recommendations:--- -------------------------------------------•---------•----------------------------------------------------- - -- -•------------------------------- - ------------------------------------------------------------------------- FINAL INSPECTION BY:_-"IS G` -------------- Date--- . —. I -' SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 Norfh "C" Sfreef Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M-8-51 Revised W-2100