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A fi �r' APPLICATION FOR -SANITATION PPSIo � � PERMIT _ (Complete in Duplicate) ate Issued Application is hereby made to he'San Joaquin Local Health District for a permit to construct and install the wo This application-is made in compliance with County Ordinance-No. 549. erein describ d. pp ff - JOB ADDRESS AND LOCATION- Owner's . 4_X1.1.Y2�d6/�------------------------------ --- Name- ks--.-✓ - �_�_ ------ --------------- - -i-.S' ----------------- e 1?3 z Address------ t_�. �-.--/�_. Phone. --'--- ------ �"-- ContraC#Ofls Name-----------o irf�_�--e 4- --------------•------------------------..._ Phone--- ---------- Installation will serve: Residence Apartment House D Commercial E] Trailer Court Motel Number of living units: -- Z ❑ Other ❑ Number of bedrooms .---_-.- Number of baths _-Z-_ Lot size -------- ---�_-x_____-- Water Supply: -------------- I Public system CommunityY s stem Character of soil to a depth of 3 feet: Sand [] Gravel PrlSandy vate ❑Loam e❑pth tCla Lo Water oam -------- ft. Previous Application Made: Yes o Clay E] Clay ❑ Adobe I Hardpan E]❑r No � New Construction: Yes D4 No ❑ ; TYPE OF°INSTALLATION AND SPECIFICATIONS: ` (No septic tank or cesspool permitted if public sewer is available within 200 fee}.) I Septic Tank: Distance from nearest well_-Vl-D n- _Distance .from foundation---4-10------------ No. of compartments--_ ---_.-__--- Materi�l---�©---- �yj - Q, Size-` X-S�( - E ----------Liquid depth--- ---�-------------Capacity --- Disposal Field: Distance from nearest w ? i -- -Distance from foundation---f n--_ --__.Distance to nearest loft l`ne.-- -- -_____ Number of lines___.----_ - Length of Yp each line__ 4 --4- - Si Width of trench-___44t, t T e of filter material-_ o,tt(C.--____.---Depth of filter material__-1S�--------------Total length__---_--�_-�„_Q Seepage Pit: Distance to nearest well-------------- - _Distance from foundation------------------- Distance to nearest lot line-_.--_-----._____ ❑ Number of pits----------------------Lining material-_+----_ . ._ WW - - -- -- -.Size: Diameter------------- ---------Depth-------------------------- Cesspool: l Distance from nearest well-----------------Distance from foundation-.--_---_-----___-.Lining material-_--_-------------------------------- - _----_----_-___. ❑ Size: Diameter---- Depth - I Liquid Capacity----------------- C1 Privy: Distance from nearest well-------------------------------------------------- gals. Distance from nearest building------ ❑ Distance to nearest lot line--_---_------------- - ------------ Remodeling and/or repairing (describe)-------------------------------------- ----•-------•------ ., ---------- ------------------------------------------------------------ { ------------------------- -i-------•------------------------------------------------------------------ ----•------------ ----------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances,iS�t/ajte laws, and rules and 'regulations f the San Joaquin Local Health District. Si nod - w �YT -------- -- By:f �• n racto (Owne and/or Cot r] _Z-�-:•1—-- ------------------------------------------------------------ (Plot plan, showing size o o}; iota+ion sof system in relation to wells, buildings, etc., can(bele�placed •n averse side]. F r FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED 13Y REVIEWED BY ------ -- ----- r =------------------- DATE---7—Po- --------------- -f- Po- UILDING PERMIT ISSUED =------- DATE Alterations and/or recommendations:-._-f--=-------------------- - - ------------ ----�- DATE ------------------------------- 7 ........ Le---- -------------------- ---------- _-Q - =` � , ---------------------------- FINAL' INSPECTION BY----------------0,__ --- ------------------ Date--------- _ r--- 7 ------------•------- SAN JOAQUIN LOCAL HEALTH DISTRICT , 130 South American Street 300 West Oak Streetf * 1". * 132 Sycamore Street 8!4 North "C" Street Stockfon, California Lodi, California Manteca, California Tracy, California E5-9-2M 10-52 Revised W-2100