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11 APPLICATION FOR SANITATION PERMIT:. Permit No. 3—il (Complete in Duplicate) _,�: To' � 0 r Date Issued _L_ ___ _.jA Applicais herebye to the Het?,}rict for aW to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. 'Z J� J JOB ADDRESS AND LOCATION.1./- ---- --------a 04----- i. � P-t$A/ 'eiN �I 4"'r, 1-p•.`..�i__ ._ .IS_.. Q' ...... --- -------------------------------------------------------- TOwner's Name.---- -----•- k-�&--------••- - ------------•----•-•---------------_-_---------•----------------------•--•-•-------------------.._..-------•---._..Address----•--•- C tractor's Name--- 171--- i Ig !''0'-----t'-S-V-�-a--=---------�N�-e-------------------•-- ----- Phone.l�:_Q_� ------------ 4. Installation will sere : Resi enc ❑ Apa nt House ❑ Commercial ® Trailer Court ❑ Motel ❑ Other ❑ o , Number o living l i g u its: ________ Number of bedrooms '= Number of baths_______ Lot size .___ - ___,_ _ � Water Supply: Public'system '❑ Community system ❑ Private ❑ Depth to Water Table _ __R ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam [0 Clay Loam ❑ Clay ❑ Adobe ® Hardpan (] 4�,, Previous Application Made: Yes ❑ No [y New Construction: Yes ® No ❑ _ O TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) 5er*c +"4" Distance frorn nearest well_________________Distance from foundation__._____--__.____.Material-__'�/r3_.�e-,7 Ve __ -------------- -7w %��° . or IX GR 'r No. of compartments------'------/---------Size_.....!yr __!�_� ..Liquid depth---_--,,� (� CapacitY sao A.C. l 6•� '' _ ' . /d �- Distance from nearest well-.- __.4____-.Distant foe oundation____1.11___.____._Distance to nearest lot line_______________ _ �,•6,T��$ Number of lines Ro 9-K-:--,F s'a T g Y --6e o^ - r1 ® t �iof�eac line r' = '�• ------------ Tj?R Type�f fil-ier matenaL_/i /PP._�.�d_Depth of filter material----------------------Total length----------------------------•------------- ` + - l'-1?--------D;stance to nearest lot line_�fl--------- Seepage Pit: Distance to nearest well___ _��--._._.___Distance from foundation___- Number of pits---------1------------Lining material 41�1.lM."r/__Size: Diameter__._ /,`l ---------------- 1F d Cesspool: Distance from nearest well-----------------Distance from foundation-------------------.Lining material------------------------------------- Size: ____._____.____.______.._.________Size: Diameter-------------------------------------Depth---:r----------------------------------------------Liquid Capacity,.............--------------gals. l Privy: Distance from nearest 1 11------------------------------- -----_-------Distance from nearest building-----------____..____________.__..__..._. ❑ Distance to nearest:lot line----- ---------------- --------lt - .. Remo and/or escribe)_:� �g - 7 ► ,` i ------------------------------ --------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Stat ws, and rules an gulations of the San Joaquin Local Health District. Fi (Signed)---------- - - !. .i '____ _ __ a.'__. -------- R___ {Ow rand/or Contractor) By:-------- G�`{ ... --------------------------------- -•--- --Title) (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed n reverse side). a F9R-REPA1FMENT 9SE ONLY APPLICATION ACCEPTED BY- -- °r - ---------- ------------- DATE- , !i REVIEWED BY-------------------------------------------- -------------------------------------------------------------------------------- DATE------r--------- BUILDING PERMIT ISSUED--------------'----------------------------------------------- -------------------------------------- DATE---------- �. Alterations and/or recommendations:-------------------------- - - -----------------''-------------------•---•---------------------------------------------------- -----------— •----------------•------------------ 1' - it -------------- !, ------ ----------------------------------------------------- •--- - --------------- ------------ ------------------------------------ /----------------------------------------------- FINAL INSPECTION"; ___ __ i- _._Date---- �_.._ SAN JOAQUIN LOCAL HEALTH DISTRICT .} 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California �! Manteca, California Tracy, California ES-9-2M 10-52 Revised W-2100 �_