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APPLICATION FOP -SANITATION PERMITPermit No. __. 6.S�� o I_) `� (Complete in Duplicate) Date Issued -_---_ ti C�r�E >f_s4�.J 0 A-V � �� Appli ion is hereby made to the San Joaquin Local Health district for a permit to con truct nd install the work here' descrd. W_j;5 This application is made in compliance with County Ordinance No. 5 JOB ADDRESS ANWLA ION_____-- /- ---gin--------- Owner's -�------� ),be Name------- -- --- - --------- -- ----------------- Phone Address------____ _ Contractor's Name___________ -------•---•------•---•---------•----------•---------------•-•------- ------•-------------------------------- Lam' --------- _ p-------------- ��------ ------------------ ------------------ Phone-----•-------------------•--------• Installation will serve: Residence &i partment House ❑ Commercial ❑ Trailer Court (] Motel ❑ Other ❑ Number of living units: ---/_ Number of bedrooms __c3. Number of baths _1------ Lot size -__.S-0-----)rf -----------------„?, Water Supply: Public system Community system E] Private ❑ Depth to Water Table _TPft. Character of soil to a depth of 3 feet: Sand ❑ - Grave( ❑ Sandy Loam ❑ Claya Loam ❑ Clay [IAdobe ar pan ElPrevious Application Made: Yes ❑ No 6____ New Construction: Yes TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) - Septic Tank: Distance from nearest wel -- __ _Distance from foundation__. ---.--_-,Material___ta --- ----- --_---_--_ -- -_--..--- No. of compartments--------- ;----_ ---Size--c,]_j , -- _{ ---Li uid de th-_ q p 1_ ---- pacity- ' Disposal Field: Distance from nearest well .._Distance from foundation--- Distance to nearest lot line---------------- - -0. • �. Number of lines-_-._�__.__. ___ f Length of each line fvF --------- ------- -- --Width of trench----_-t2...------ ------. Type of filter material- --.�---------------Depth of filter material-._-- QQ --CJ--.�------Tota! length----- --0 r Seepage Pit: Distance to nearest we1f,. �`�!L------Distance m fou dation___�'p_-_ Distance to nearest lot line_- T Number of pits --- // Linin materialQ�. ., jf el - 9 - Size: Diameter-•T.�'- --------De th _ _ _____ 1 Cesspool: Distance from nearest well___ _______ p �J- � 1771 Distance from foundation------- ....._Lining material-- _-------------------- 5 Size: Diameter_ ------- -Depth-----:----- - Liquid Capacity ---•---gals. Ho Privy: Distance from nearest well-______________________ J-- -------------- ------ from nearest building El Distance to nearest lot line.____...-.______.___-._ ---------------------------------- Remodeling and/or repairing (describe)----------- --- ,11.. ---------------------------------------•--=----------------- '-------------•- ------- ”. ,_ ------•-------- ------------•--------------------------- --------•-----•--- x---------•---------•-----•---------------------` * - 7•.. - 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 r a regulation of the San Joaquin Local Health District. (Signed).---- -. . / ------------ --- ------------------ ----------------------------------------------------{Owner By----------•----------{_ - -----• ----------------------------------------------- (Title) ----- -- - ------------------- -------------- (Piot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). {.l FOR DEPARTMENT 115E ONLY APPLICATION ACCEPTED BY....-................... REVIEWED BY-------- -- - - - DATE --Q-----------I- --------------------------------- - --. DATE i3U1LDING PERMIT ISSUED----------- ------------ ------� -:-- ----- - •---•--------------------------------------- ---- -----------------••---------- Alterations and/or recommendations:_.__--.__ - DATE------------------- ` ------- ......--- --------------- = ---------•---------------------------•------------•-• -------•---------- .---- - ------------------ !-___-__ _ - - �._f..--- .'----------------------•_---.------ .---- -_ :. s - ------------------------------------ FINAL INSPECTION BY:....... -.<s ,/� 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 Mantaca, California � Tracy, California ` /2M 145446 AT1,..D 12-54 .