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r1�" APPLICATION FOR SANITATION PERMIT Permit No. ------ (Complete in Duplicate) pate Issued _41!g_I_�_9-- Applica}ion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. e�NThis application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION---,-<� --.a-----�`,- =`-!2- b-•-_�--- '''1----------------------------------------------------------- -Owner's NamePhone_,:._' = "': � y .' s- Contractor s Name = . •--•-p°--- 4'-=----_`-•---•-----•--,_.._a_r Phone.. Installation will serve: Residence Xpartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __!__ Number of bedroomsNumber of baths ., ____,Lot size -__G_- 5- -!'-=5----------------_________________ Water Supply: Public system ® Community system ❑ Private ❑ Depth to Water Table __�7ft. Character of•soil to a depth of 3 feet: Sand ❑ Gravel [❑ Sandy Loam ❑ Clay Loam ❑ Clay E❑ Adobe[R Hardpan ❑ "Previous Application Made: Yes 0 No ❑ New Construction: Yes ® No ❑ 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-----------------Distance from foundation--------------------Material-----------------, ______._______________________. -- :?'- +-' No. of compartments------------ -------------Size--------•--------------41,_Liquid depth--------------------------Capacity----------------------- w Disposal Field: Distance from nearest well-,� ------------Distance from foundation--------------______Distance to nearest lot line---------------- Number of lines---------------- - ---------------Length of each line-----------------------------.Width of / trench------------------_------------.... TYPe or' filter material---------.----------------Depth of filter material--------------- -------Total length------------------------------------------ Seepage -----------------------------------------Seepae Pit: Distance to- nearest well_r,.-o:,-4-------Distance from f undation-.moi.-yam �,Distance to��earest lot of pits-_____,�.__.____-Lining material.�'�_-'._.;.�_---.Size: Diem ter____" L Depth- Number =*'�'_ Cesspool: Distance from nearest well _____________Distance from foundation--------------------Lining material---------------. ......_............ ❑ Size: Diameter.-- ------------ --- ---------------Depth--------------------- ----------------------------Liquid Capacity----------------------------- -------------------- ---gals. C1tI Privy: Distance from nearest well--------------.------------------------------Distance from nearest building------------------------------------------ ❑ Distance to nearest lot line- --•----------------------------------------------------"---------------------------------------------------------------------------------- Remodeling and/or repairing (describe �.��2'tr-� _ ' ". f��M`-------- �'L____..zr i-d_----- �____. �- r . r , v _ ______ __ __ _ __ _ -------------------------------- _ _ .. __ ___________________---....-___.____.______._--_____._____------__.__-.__._______..________________________-__-. I hereby certify that I have prepared this application and that the work wili be done in accordance with San Joaquin County ordinances, State laws, and rules and-regulations of the San Joaquin Local Health District. (Signed)---`: 0*'7 Ox-t4 9 . �---- .. and/or Contractor) By:._E�r.�� __..'`ti_�:'�' ------ -- --.--------------- --------------------------------------------------------------- Title r - --.(Plot plan, showini 'af`F6t, location of system in relation to wells, buildings, eft., can be placed on reverse side,. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------------- - - --- - - -------------------------------------------------------------- DATE----- � � REVIEWEDBY------------------ ------ ------------------ -------------------------------- -------------------------------- DATE_.--- ---------- - ---.- .-. -------------------- BUILDING PERMIT ISSUED.....-•-----•-------- ------------------------------------------- c. : � DATE--A-----_------------------J--- ------------W-�- ----------------- w Alterations and/or recommendations:-- .-- ------- 41 4 ^� t-•rf'--�---�.,--f h.�C-C'=tip'[- / / '/ _ r FINAL INSPECTION lfflC ._ f - BY - --- -- -- -- ----- v:.�.---.. --- Date-7-77? ---------- - -- SAN JOAQUIN LOCA EALTH 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' 145446 a-rw000