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APPLICATION FOR SANITATION PERKSC Mae NAN o. (Complete in Duplicate) IJ 9ued ..-71ilT Applica+ion is hereby made to the San Joa in I� �DI t ict for a permit to construct and install the work herein described. This application is made in compliance with ur} CJrl Snca . 549. JOB ADDRESS AND LOCATION - - ----------- J---- F --------------------------------------------------- Owner's Name /-.-Y..d 1 Q !g L 2 -- - - Ph Address------`2 5 ..- .. 1 one - - ---------- Contractor's Name----.--. -.-. ti - ' ---` ------------------------- - - ---------------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -./.--- Number of bedrooms ._ - Number of baths _/-..- Lot size _,,6�- --- ----� Water Supply: Public system [� Community system ❑ Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe a Hardpan ❑ Previous Application Made: Yes ❑ No [2FX New Construction: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic it ,or cesspool permitted if public sewer is available within 200 feet.) Septic Tan . Isf ce from nearest well----------------- from foundation-_---..-.._..-_-.Material ❑ _ (�Jo. of compartments-------------------....Size-----------------------------Liquid depth----------------------Capacity--`---------------- Disposal Field: Distance from nearest well oy.z-Distance from foundation.-.�7-----.-..Distance to nearest lot line_--_�S © Number of lines-------.---�_:.... . ,,Length of each line......----i f -----,---_Width of french_..�.�.'.e-------_--------- ype of filter material.---- ._i___ _((+Depth of filter material-._..G-`.__.-..Total length.__---.fid__.-..-------_--- ... Seepage Pit istance to nearest well----yam-__Distance from found tion...Z.Ct-d.-_-....Distance to nearest lot line-.--- r� �(] Number of Pits_...__./_...-.._..Lining mate rialA?k�_7 e: Diameter-------- '.`....Dept h_...25' ('1 Cesspool: Distance from nearest well------------- ---Distance from foundation.._. --------------Lining material_--------------- ----...........--- `Y ❑ Size: Diameter.. .. ..... — --------- -------..Depth------------- ----- --- --...------------------Liquid Capacity- ----------------------gals. Privy: Distance from nearest well------ --- ----------------_.._------ .--------Distance from nearest building - - ------- F] Distance to nearest lot line...�-'-/J--/-�------------...------------------------------------------------------------------------------- Remodeling and/or r pairing (describe):.._._._.L�a. -_ �7 y —aS/�La --------- - ----- -------- - - - - ---- ----------------- ------ - - - - -- --- -------- -- .. ----------------------------- I ----- ---- - -----------------------------hereby certify that I have prepared this application and that the work I be done in accordance with San Joaquin County ordinances, State, and rules and regulations of the San Joaquin Local Health District. (Signed) ---- 9 ) -,/---- -- -- - -- --... -- r --/ ( w ner and/or Contractor) By:----.—' c 2�, r----�.. ----------- '--------------- Ttle-- (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 APPLICATION ACCEPTED BY.-- -------------- - - ------------------------ DATE.----------------------- -------- -- REVIEWEDBY----------------------------------- -- - - ----------- ------------- ----- DATE._-- ------------ BUILDING PERMIT ISSUED.........----- DATE--------- Alterations and/or recommendations:_._..-_._ U._. ----- ------------ - - - - - S ----------------------------------------------------_------. ----------------------------------------I----- ------------------------ -----------------------4_--------••--_-------- _-.-----------_------------------------------- ------------ ------------------------------------------------------------------- --------------- ......------------------- ------------------ - - - - - -- ....-- - _--- -- ------------------------ --- - - -- - FINAL INSPECTION BY:_..-. 'L � .... --- Date.._.-- `.---.._L9----SAN JOAQUIN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Sfree} 914 North "C" Streef Stockton, California Lodi, California Manteca, California Tracy, California €5-9—ZM 145446 ATw000 1254