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APPLICATION FOR SANITATION PERMIT Permit No. _A� Y5( (Complete in Duplicate) Date Issued ___lys_/�_ _ Application is hereby made.to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. JOBADDRESS AND LOCATION--- f'. 7- ------------------------------------------------------------------------------------------------------------------------------------- Owner's Name- Lr_ er'1" _ _ ------------------------------------- ------------------------ Phone------------------------------------ Address..----•--�,3$7----- Contractor's Name--- !� 1�._._ �_.__ a� + "�rlslC ----------------------------------------------------------------- Phone_16/0--4-!�7;'-71 � Installation will serve: Residence ® Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _-_-)-- Number of bedrooms __3-_ Number of baths __J____ Lot size _____GOA/00________________ __ -- Water Supply: Public system ® Community system ❑ Private ❑ Depth to Water Table _ _S___ ft. # Character of soil to a depth of-3-feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adore ® Hardpan ❑ :.ai Previous Application Made: Yes ❑ No 6Q New Construction: Yes ® No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) ` Septic Tank: Distance from nearest well---ttome--Distance from foundation___j_Q_'_______-__Material---1kdA4_4!f_ i A No. of compartments----14-----------------Size-------A !'-----------Liquid depth__.-r/_0------------ ----Capacity.1pp-7-w/---- Disposal Field: Distance from nearest :-_Distance from foundation---1O!-----------Distance to nearest lot line__s0______- [A Number of lines----------------3---------------Length of each - _2.1_'__--Width of trench------3Q-"*------------------- 9M-+ Type of filter materiaL_____��C/t-------Depth of filter material___ki'f------------Total length------tU!_____________________-- sq, -Fit: Distance to nearest well_--vome—__-____Distan rom o ndation__y4............. to nearest lot line__-4".__:_.__ ® Number of pits-------- Lining materia '�o - '-_-.Size: Diameter___=3.0�_7�_..___Depth-- '-----------___ ________ Cess ook Distance from nearest well-----------------Distance from foundation--------------.-----Lining material--____-____-______.__: ❑ Size: Diameter------------------------- ------Depth---------------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well----------_---------_-----------------------___-Distance from nearest building________-__---__--________________.__._._. f ❑ Distance to nearest lot line-------------------------------------------------------------------------------------- ------------------------------------------------ Remodelingand/or repairing (describe):------------------------------------------------------------------------------------------------ -----------------------•-------•------------------------ _„ -----------------------------•------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ 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 rules and regulations of the San Joaquin Local Health District. y - ♦ .1 (Signed).........�kl�----- G,p._ 4-----7 -4 (Owner and/or Contractor) ---------------------- By:---------- -- -----------------------------:----------------------------------------- -----(Title)-------av,,&"� • v� (Plot plan, showing sizof lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). F FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------- ------------------------------------------- DATE [� REVIEWED BY ! N -- DATE------ 9 } - ' — -------------- BUILDING PERMIT ISSUED ------- -- '- 4 -- --/ ------ ----------------------- DATE-----------�------------------------ -7 Alterations and/or recommendations_________________________ _____ _-__-------------------------------------------------------------------------------------------- ------------------------------•--------------------•----------------------- --------------------------------------------------------------------- ----------------------------------------------- -------------------- -------------------------------------------------------•--•--------•-------------------- ------------- -------------------------------------------------=-------------------------------------------1------------------------- --------------------------------•------- --------------•-------------------------- ------------------------- ------------------------------------------------------------------ ------------- ------------------------------- ' ------------- --------- ------------------------------------------------------------------------------------------------- --------------------------------------------------------------- --------------------------- r- FINAL INSPECTION BY:----` 1 ------------------------ Date-- — = --------------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT i 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockfon, California Lodi, California Manteca, California Tracy, California E5-4-2M Revisea 3.57 F.P.Co- -