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APPLICATION FOR SANITATION PERMIT Permit No. �9 (Complete in Duplicate) - q•� Date Issued .__3,1�_�/3� Applica{ion 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. JOB ADDRESS AND LOCATI`ON----.... ;la : 13a�2--•------------------------------------------------ Owners Name------- G!�'�j F�`. /�I" �ILe • -•-•- - -- --------------------�---------14'a.0-_C_ ------------------------------------ Phone------'�-n'=----------------------- Address------------- -----------------•--- Address------------- Tt7?-P __ GiLuf'r~';i �'iz.� eaF7��j[-----•--------------------• --- Contractor's Name---- 1---------------------------------------------- Phone_Ap.-a_24?_4/4.------- Installation will serve: Residence [jo---Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _i��mmunity mber of bedrooms _4 Number of baths ._.�C_ Lot size -___._� _9" ____�_3_----------------- Water Supply: Public system system ❑ Private ❑ Depth to Water Table vft. Character of soil to a depth of 3 feet: Sand E] Gravel E] Sandy Loam ❑. Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑ No [J]/New Construction: Yes LxNo ❑ x r i rs c� 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__.r Q_._.__Distance from foundation---IP____.__.Material---- __.________'__ ---------------------- ❑/ No. of compartments__2w---___-_"___-_..__Size,_-��_____._�'�Liquid '� r Ca acit �v Disposal Field: Distance from nearest well„V__ -___Distance from foundation__�0_�.__._-.Distance to nearest lot line_______a Number of lines___..a-----_-----------_--------Length of each line_.j_0__0____r0'�_.WidA of trench---.a2_d/' ----__-_____-.__ Type of filter material-� arl21� Y-Depth of filter material----Z_8. .......Total length-.-c?C.✓-------______________________ fr foundation--- Distance to nearest lot line____4__________ Number of pits----- Linin material___ Seepage Pit: Distance topeares�well-/Q�C!_'-__�___-Distanc��rn� Size: Diameter____ .��__-"-Depth_.Z.��- Cesspool: Distance from nearest well------------------Distance_ from foundation.- ._-_-__-_______.Lining material________________________________- ❑ Size: Diameter--- ------------ ----Depth-- --------------------------------------------___.. Liquid CapacitY ---gals. Privy: Distance from nearest well--------------------------------- "_______...._Distance-from nearest building -- ❑ Distance to nearest lot line--------------------//------------- -------------•----------- •------------------------------ ----- --------------- ------------------------ Remodel' ---- ----- ----------Remodel' and/or repairing scrib ':___ s -_� --------------- -• ` e ---- . . ----------------------------------- y'_ , :. �!G- �7�s � _---------� ' -S? -------- _ -4, ------------- I ereby certify that's have prepared this application a d that the wr�will be done in accordance with San Joaquin County ordinances, State laws, and rulevAri�� of the San Joaquin Local Health District. �. , Septic Tank Service Contractor) (Signed)-------- --------130b3o:Eti{ar�do-- }t0-2�70�46------- ---- ld',2 By --------•- _ - S10CMcn, Calif.------------------------------- --------------- Title)---k4.1__l1_ Q-f ----------------- [Plot plan, showing size of lot, location of system in relation to wells, s, etc., cfn be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------------------------- -- ------------------------------------------ ( � DATE---------- REVIEWEDBY ---------------------------------------------------------- DATE BUILDINGPERMIT ISSUED-------------------------------------------------------- ------ DATE----------- -------•----------------------------------------- Alterations and/or recommend ations:------------_----_ _ _____ _ --' ------------------------------------ - S- ` ---- ------------------------------- ---------------------- ---------------T-•----------------- ----------------- ------- -- ------- - -------------------------- ----- ---- -- ------ --------------------•-------•--------- -- --------------- ------------------------------------ 73 ' 3 -J-C FINAL INSPECTION BY: ` - - Date_ --- -- -------------------------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street i'32 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ' Es^9-2M 145446 ATWOOP 12-54---��•�-+�+.c. - '\� ,;�ww