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a APPLICATION FOR SANITATION PERMIT Permit No. -: (Complete in Duplicate) _ _ •�� .... . _ Date Issued ---`y--�--'�- Applica4ion is her m6de'to the San Joaquin Local Health District for a permit to construct and instar the work h� This application,is made in compliance wifh County Ordinance No. 549. erein described. JOB ADDRESS AND LOCATION_---- _ ." � .t�_ ¢ # ----------------- -------- Owner's Name_ ----""_"--_ " _ _ CSO-, _ ,gyp n -e Address------..__ ".�4,¢ �e,• .WPho e_ /�/ -------------------------------------------•---------.------- - a--- Contractor's Name--------------- - f �] r31 - •----- Phone Installationwill serve: Residence.[B-_'Apartm-e.nf`-House ❑ Commercial Trailer Court Number of living units: __ __ Number of bedrooms_ ❑ ❑ Motel ❑ Other Number ❑ c 'Number of baths _ .r. � _ ----- Lot size ----SQ---_--� .� ti_p-�-� ---------------- Water. Supply: Public;systemT'J Com.munity_system,❑ ' Private❑Ge th to Water Table + ` -- p '1"� ft. Character-of soil to a'`depth of 3 feef: Sand ❑ Grave! ❑ Sandy Loam ❑ Clay L #. Yoam ❑ Clay ❑. Adobe a Iardpan ❑ Previous Application Made: Yesi❑--No ®-'New Construction: Yes �o ❑ F TYPE.OF INSTALLATION AND SPECIFICATIONS: - g, (No septic fank`,or cesspool permitted if public sewer is available i+hin 200 feel.)'`? j Septic Ta Distance from nearesr well_ -----Distance from foundation__./d-" r y R. No'..of compartments-- -- ..................Size-S. �Xf/d' ' Liquid depth__M�Y Capacity. ECa a _ Disposal Feld: D �' Distance from nearest well "." Distance from foundafion___Z __-__°---"_Distance to nearest lot-line_5� .___" Number of lines__=._-�-. -- r Length of: lined----------------Width of french Y_�� = Type os filter material__$•. o-Ger---_Depth of filter rnaferial____/._ _'--" ' X5'0 ""'7--Distance' ..�-m �, . - _.. ,.� r—4 ; � Total�length ------ --- ----------------!---------- Seepage it: Distance to nearest well_��Q" Distance from foundation__. l'-• Distence`fio nearest lot line___.._s�__"_ 6 Number of-pits___ _____________Lining materialDiameter__.-3.----- "----- h_ - . . Deptn----�-- Uf Cesspool: Distance fro ' nearest well__------____Disfanae from foundation ___-. `._ .Lining material_. ..____ _ _ --------- ---------------------Priv❑ Size: Diameter Depth = ,.-----•-=-------------------------------- Liquid Capacity gals. f �. `- Y Distance from nearest well----------- _ __.-____...._Distance from nearest building . . Rem❑odelin and o Distance to nearest lot line-------- --- - T - ------------- .. ---------------------- --------------------------------------- 90 r re' airin describe 4 g pt g a --------- --- ---- ---------------------------------- rx : i - - - .. s - - -- I,hereby certify,that I have-prepared this application and4hat the work will be done in accordance with San Joaquin County ordinances, State laws E_nd rules and regulations of the San Joaquin Local Health District. V (Signed) --- s ------- --- --- -"•-- O ner and/or Contractor By:-------------�` t'ex-�G� l,.tJ •. � ----- ' (Title Plot plan, showing size of'lo+,.location of sVstem in relation to wells, buildings, etc., can be placed.on reverse side). FOR DEPARTMENT USE ONLY , APPLICATION ACCEPTED BY --------------------- REVIEWED BY- ! :r i ----• DATE. `� 1r --- - DATE BUILDING PERMIT ISSUED----.----------•----''-------=-- T . I ---------------------------------------- --------------- ----=--------------- ;-------------- DATE._ == Alterations and/or recommends#ions:__.__-_"_______________ -----------•--•------- ------------- . -------------------- ------------------------------- •---------- --------- ---------------------------- ------- t € --------------- ---- _ --------------------------- li - - f FINAL-INSPECTION ABY:_- ""..�' W _ __ �4 � . 'a 2 r -------------- -Date_ ! SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Streat 300 West Oak Street 132 Sycamore Street e14 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California E5-4-2M ; IRevised W-2100