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Y � APPLICATION FOR SANITATION PERMIT Permit No. ! ,6 l�yl� (Complete in Duplicate) Date Issued ------ Applica+ion is hereby made to the San Joaquin Locai Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION ---- ---- -------- -------- 1 ----- Owner's Name-------- -[�/�_ ---� ---f_Al/-----------.-_P P ----.., Phone N. Address ------- -_ /--• .L 1 --------------- - --------- ----------------- ----------------•-•----------••-------------- Contractor's Name--------PARRI-S. -h-------- , ----- Phone Installation will serve: Residence IN Apartment House C ❑ ommercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Wafer Supply: f living units: _l____ Number of bedrooms __3_ Number of baths __/-__ Lot size __•�-�- Number of livin unit system X Community system ❑ Private ❑ Depth to Water Table _4_0 ft- ' Character of soil to a depth of 3 feet: Sand ❑ Gravel Sand Loam Cla Loam Cla € ❑ Y ❑ y ❑ y ❑ Adobe� Hardpan [] Previous Application Made: Yes-0 No K New Construction: Yes5Q Non , TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance,from nearestwell ll__ - -4 1 istance from founclation__l4)--�_--- ---Material----�__� �_- •[ No, of compartments__.-_- --------- 6._X_ --__Size__ _ ` �--Liquid depth_..._ 6------- Ca1?aci tY----_e_a_�--- Disposal Field: Distance from nearest weil_N�pistance from foundation__.__ .__I- Distance to nearest lot line___-d"_ Len th of each-liner-_ . Width of trBnch_...__,. ---- -------- -- ® Number of lines---------- - --- - ------ �1 Type of filter materiaL_�- '_-_ _IDepthof filter material------1_-g- Total length--------09_ ---------_- C , Seepage Pit: Distance'to nearest well__ Distance from foundation___ .0---r.Distance to nearest lot line___ Zr 1 ( Number bP pits.._. -----Lining material---- -C-..Size: Diameter---�.--00 s-------- Cesspool: Distance"from nearest well________________ Distance from foundation. __.____-._._.___ .Lining material^________-.._____ .__._.-_______.___ ❑ Size: Diameter-- Depth _ _ ------------------------Liquid Capacity----------------------------gals- Privy: Distance from nearest well _.____------------------------------------._-__-Distance from nearesr building ❑ Distance to nearest lot line___-____--------------------------------- Remodeling a /or repairing (describe):__-_ ,_ 1 _ , •----------------------------•------------- _.:4----------•--------------•- ---------------------- --- ocv-----------------=----- ------ - - --- ----------------------------------------------------•----------------------------•--------•---------------------------------------------------------------•----------------------••--------•------------------------ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Sfafe.daws, and rules`and regulations of the San Joaquin Local Health District, (5i ned �� 9 ) ------------------------------------------------------(Owner and/or Contractor] Title ` (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--- y� REVIEWED BY - - V ----- -,�- --------------------------- ----- . 9 DATE 7XI BUILDING PERMIT ISSUED------------- DATE------------.----- �, - A! atio and/or re ommendations 114. ie � ------------_- _A----- ------------------- y F1NAL INSPECTION BY:--- -- .r-- Date----- ------- - SAN OAQUIN LOCAL HEALTH DISTRICT 130 South American Street .�.. 300 West Oak Street 132 Sycamore Street $14 North "C" Street Stockton, California AX-9f-94- di, California Manteca, California Tracy, California E9-3 145446 ATWppp