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'T APPLICATION FOR SANITATION PERMIT �r Permit No -------------• --- (Complete in Duplicate) Date Issued `3t` 1 to the San Joaquin Local Health District for a permit to construct and install the work herein described. AppGca+ion is hereby made This application is made in compliance with County Ordinance No. 549. 9 !9 ----------------------------------- - -- ---- 7 sou- JOS ADDRESS AND LOCATION -__ Phone---------- --------------------- - - _ --- ----------------- ---------- ---------------- Name---------------=- ------- ----•------ - r" ---------•--- ------------------------------------- Owner's / ~ Address--------- ---------- - --- ` Phone_ .7 Contractor's Name-- ---------/ T-C-----• Ll Installation will serve: Residence ��Apartment House ❑ Commercial [I Trailer Court ❑ Mote! [I Other [I C Number of living units: Number of bedrooms __ Number of baths,.-,/-- Lot size -__ Qd___-- 1 ------------ ` Private a th to Wafer Table /4 ft. Water Supply: Public system-'.' Community system ❑ p i \� ' Character of soil to a depth of 3 feet: Sand F1Gravel ❑ Sandy Loam ❑ Clay Loam E] Clay El Adobe Hardpan ❑ I. Previous Application Made: Yes E]9 No l❑�b1ew Construction: Yes [r}/No [] k 1 TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool'permitted if publicewer is available within 280 feet.)i �� rlo Septic Tank: Distance from nearest well_---J- -_/'Distance from foundation_-- � material -- Size `��-j � � Liquid depth ) ----Capacity----�5[7G�v Nok of compartments------- -------- f ` . �D� r Disposal Field: Distance from nearest well._.--_-..-_-----.Distance from foundation-`-_�-�j__--.Distance to nearest lot line_________________ Number of lines---------_ Length of each line- _ _ X6,4----Width of french_--_-1�_5�_-- --------------- 9 n S'✓ - Type of filter material-._---_-� ��-__Depth of filter mater{al- _�g-`-------Tota! length------� �---------• 1 Seepage Pit: 'Distance to Barest'wel4 --------------------Distancea. from foundation--------------------Distance to nearest lot line------- a x •-� �Y- ❑ Number of pits. =Liningaferial . , Size: Diameter -Dept'n- = Cesspool: Distance from nearest well----------------)DistanceJrorTi foundation.-._-.---__.---_--..Lining material___.----- _-- _______.ls. ❑ Size: Diameter----------------- ------ - Depth ------- -------Liquid Capacity- ---------- :gals. I t . PrivDistance from nearest v✓ell----------------'--------------- --------------Distance from nearest building-_--------__---------------------------- Y.; , -------------------------------------------------- Distance to:nearest ofI ----------------------------------------------------------ine.. ---------------------- _ L �d or re air' e ri r Re Qde g P g -- ----------- i ---- - }' x ---•--- p� ---------------.--_... g-- *-s-- __- ----- .�----------------------•---------------------------- -------------------- ----------- ------------- i --------------------------- 1 --------------------------------- -----------•--------••---------•--------------------- I!hereby certify that l have-prepared th�sapp' tion and that the work will be done in accordance with.San Joaquin County r ordinances, State. laws, and rules and regulatio s--of the'San Joaquin-Local.:•HealthTDistrict. I i . R - n r ontra / -- All -(Owl,4r and/or C ctor k [Signed). -- -- { ----- Title)---- ,✓-- --------- ---------- -- - -- --- ----------- BY l [Plot pian, showing size of lot, location of syste in relation to wells, buildings,-etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY DATF�—_ APPLICATION ACCEPTED BY- ------------------------------------------------------------------------ ------------------------------------ DATE__ ----------------------------------- REVIEWEDBY------- -------------- --- ---- --------------------------------------------------- - BUILDING PERMIT ISSUED--------------------------------------------- - ='Y DATE-- � -- ----- --- ---------------------------------- Alterations and/or recommendations----------- ----------------------- -------------------------- _ -- ----•----_------ 1 / -------•-------------- ---- ---------------------------------------------------------- ------ ` / Q' ----- •-------•------•------------------------ ----- - I --------------------------------- -------------- - --------•-----•-----------•---------------------- ---------------- 7 ---"----------------- -_---_- K ---_--- - -. �. ---------- w -r::' • / Date--- ( - i _ FINAL INSPECT16N1\1 --------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 300 West Oak Street 132 Sycamore Street $14 North "C" Street -1;W { 130 South American Street Trac California Stockton, California Lodi, California Manteca, California y. ES-9-2M Revised W-2100