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APPLICATION r FOR SANITATION PERMIT, Permit No. _lC�_. --Q +�.. 9^" (Complete in,Duplicate) , n 4_ ' Date Issued Application is hereby made to the San Joaquin Local Health District for a permit.fo construct and install the work herein-d This application is made in compliance with County Ordinance No. 549. escribed. JOB ADDRESS AND LOC•--1AT-I.�ON�-�-----L--'�.j .�S_ltlti_ /7e 3 � _____--`-._______________ .__ ! ---- ____._.__.___l________.._.y,--------------------- N �_-_-__.964_ _________- Owner`s Name------ ------------ ---- phone___Address }------------------ ----•--•-- --------LO------q Contractor's Name---------• 3_a& Phone Installation will serve: Residence R11,Apartment House E] �Commercial [:1 Trailer Court E] Motel El Other ❑ •°'i + Number`of living units: __7__ Number of bedrooms -2___ Number of baths-)( Lot size -L K C$- V titer Supply: Public system Eq-- Community system ❑ Private ❑ Depth to Wafer Table -------- ft. Character of.sail to a depth of 3 feet: Sand ❑ Gravel [] Sandy Loam ❑ Clay Loam [] Clay ❑ Adobe 9--'Hardpan ❑ Previous Application Made: Yes ❑ No Q-�New Construction: Yes D�No ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic'tank or'cesspool permitted if public sewer is available within 200 feet.) eptic Tank: y Distance from nearest wellZlT� __.Distance from foundation_--1-Q____-___ _.Materi-a--lNo. of'compartments C ---- ._ _____ ________'_______ ____-- __._______. --____--- . ?` - �- -,_._ uid de ----- ----- ------Capaci Disposal Field: ,Distance from nearest well_`7v -Distan`ce..frorn foundation-_--/D----_. Distance to nearest lot Iine__�_______.___ ❑�I #Number'of fnes_-------� -------•---� Length_,ofeach,line ---�-�-.---------- --------Width of trench �� r of « - ---------------------- Type of filter maferiaI____-YD&---------Depth filr.material_ -------Total length-------- 7�a a '6 Seepage Pit: Distance to nearest well '_____________ __ , ---Distance from foundation_----------_------Disfanc'e to nearest lot line_________________ � El 1 Number of Pits----------------------Lining ------ . Size: Diamefer----•------------------Depth------ ------------------------- X Cesspool: Distance from nearest well_________________Distance from foundation__.______.-_- .Lining material--------------"_---___-.__ -_ Prig❑ D+stanDce n romr nearest well Depth Liquid Capacity -------------gals. ❑ ------ ----------------------------_Distance from nearest building Distance fo nearest lot line--_-_: ':..__---_-- --.--�r " I Remodeling and/or repairing (descrif-)e)._':,-__;;,-: . ---- ----•--------------------------------- ------•------------------------------------------------ ------------ ------------------------------------- V►� ---------------------------------------------------------- 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 re ulations of the San Joaqui tical Health District. (SignedL. ----- ---,; dC� --- -----------------------------------------------------------(Owner and/or Contractor) gY= 6 - ---------------•------------------- ----------------- 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 BYti - --- -------- ----�---- ------------------ DATE )�� J REVIfEWED BY __.T _ - - - --- --------------- DATE---- ' "- BUILDING PERMIT ISSUED------------------ - --------------------- --'-----------------•---------- ----------'- DATE----- -----'------------------ - ---------------------------- aerations and/or recommendafions--------.---------- -_ ---------------- _________________________________________ _ k --------------------------------------------------------------_.-----_-_ ---------------------------------- ------------------------_________ FINAL INSPECTION BY___ ! - --- ----- Date .1./.U _r SAN r JOAQUIN LOCAL HEALTH DISTRICT '130 Soufh American Street 300 Wes+ Oak Street 132 sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California E5 9-2M Revisea 1.57 F.P.CO.