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l} Permit No. ...1�!_L.!-__-. APPLICATION FOR SANITATION PERMIT �}d (Complete in Duplicate) Date Issued Applicakion is'hereby made to:the San Joaquin Local Health District for a permit to construct and install the work herein describes. 4 This application is made in compliance with County..Ordinance No. 549. ' -0- �, �„�, ,I I JOB ADDRESS AND LP TION_____ O_9, . , a 1 Y - -r ---- --- G-� ?%- --L --- ------------------------ n ,(� _ P ne-----•--------------- Owner s Name =!` �1 _.. r:� ll.x.J' f • --------- - -----• ----- k Address------ `7 �-- .------..G�- �v ------------- ---------- ---------- �----�--------- -----------,------ ------ Poe � ------Con+rectors Name , Installation will serve: Residence [N. Apartment House ❑ Commercial ❑ Trailer Court ❑ .`Motel ❑rJOther ❑ \\ ` (� X g Number of living units: _�.I-"- Number of bedrooms __ . Number of baths _-f---_. Lot size --___---__.___--_---------------------".__"-"___-_"__--._ Water Supply: ";Public'.systim,M� Community system ❑" Private [:1 Depth to:Wate�Table _5p ft. e ' Character of soil fo a depth of 3 feet: 'Sand' ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 2- Hardpan ❑ Previous Application Made: Yes ❑ No PS.- New Construction: Yes Nor] } TYPE OF INSTALLATION AND SPECIFICATIONS: f (No septic tank`or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well_:Ivd;VL -Distance from foundation___-- °..__.__._. ateriar_p -��_��___,.-----__... No: of compartments------ -.-- Size__ ___x- _ :._.Li uid _e t __4__6------------Ca acit 510" _,� � e Disposal Field: Distance from nearest � wel ..i44."'Distance-from foundation_-----L4-{_..Distance to nearest lot line -- __--._- Number.oflines__ _ !Length of each line. ____ 6 -----Width of trench..__,'?,_V:"" .Type of filter ma+erial----I✓=-----!-�Depth of filter material-_--_-_ --------Total length---______ ,5?_-_____.._____---_- Seepage Pit: Distance to nearest iwelLA_. 11� __=Distance from foundation....................Distanzp to nearest lot ling .,. `i J Number of pits....:�_-"""__-"___Lining_,material_��.__--- .W66: Diameter__._ p .� ' ---------`De th-'r - ----- r 1 _. . i Cesspool: Distance from nearest'Well----------------!Distance from foundation_..-----------_-----Lining material--------------------------�_-------- El Size: Diameter:--`------- --------------- --------De th-.-------' -------------------=-----!--- Liquid Ca acit -------gals. Priv Distance from nearest well_.__. ; --- _.-.---: Distance from nearest building__`__.------------------------- __ ❑ , , ., Distance�to nearest lot line--------"�-._..v_------------------------------------------------------------------.._ ,,,.. .�.. ". � . ---------------------------------------------------- Remodeling and/or rep _- , � Remoairing (describe):- ------- -- ,.. t i ' t - ----------------------------------------- ---------------------------------------•----••-•---•--------------------------------------------------------------------------•-------------------------------------------1_---- . -- , - : --- I;hereby certify-'tha+-I have prepared this,application and that the work will°be done in accordance with San Joaquin County rn ordinances, Sta ws, and-rules and regulations of the:San Joaquin Local Health District.` , (Signed) I � ; �` V t } r t (Owner and/or Contractor ---------le $y:---..r_ _ z --------------------------- ------------==----- -(Tit ) ----- ' -- (Plot plan, showing size of lot,,location of system in relation to wells, buildings, etc., can be placed'on reverse side). r � �. FOR DEPARTMENT USE ONLY i APPLICATION ACCEPTED BY-------------- ------ ---- I-- --------------- ----------------------------------:-----DATE------0-•-------------------------- --------------- REVIEWEDBY = = --------- ---------------- --' ----_ DATE-- ------ ------� ----------------------------------- BUILDING PERMIT- ISSUED----_--_--_-- ----------�44-------- - _ ----------- DATE......._._. -�_ ------ - ---------------------------------- Alterations and/or recommendations:____:----------------------------- _ -_1. a --------- - 0 - --- . ----------------------- ----------------------------------- ------------------ .----- ---- ---------- ------------------------- •. . -:'�---------------- _...--.A1-� �'= rte•&-------------0- : .. _ -----•----•--------� ------------------------- •------- FINA--------------------------- --------------------------- -------•----- -" .:..._ �.�.. jj til L- INSPECTION BY:_ ` ----- == =-- Date--------/-o SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stocktan, California Lodi, California Manteca, California Tracy, California ES-9-2M Revised W-2100