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lee APPLICATION FOR SANITATION PER)Oefl' Permit No.ea_.A.f..3... (Complete in Duplicate) Date Issued-- �-5...7/lae Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the k herein described. This application is made in compliance.wit County Ordinance No. 549. 11 7 q JOB ADDRESS AND L ATION - IST 47- ^ cr ------------------ ----------w' ac,---- G"f Owners Name -------------------Jt'-- Phone---------------- -- .--- - ---- ----------------- - - - --- ---------------- ---- ------ -------------------- °' Contrector's Nam ------- --f Phon . - -------7----- --------- ------------ = =77 7. Installation will some: Residence Apartment House Commercial ❑ Train Court E] Motell ❑ Other P ` Number of living units: ---I--- Number of bedrooms .J_. Number o baths -1--- size 1-12.0.____x..LCt2� ------------- Water Supply: Public system E] Community system C1 private Depth to Water Table -.-____. ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam 5T Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ e` Previous Application Made: Yes ❑ No ER`� New Construction: Yes [P/No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if publicrsewer is available within 200 feet.) f Nee Dista�ce/�rom found ion___ Septic ank: Distance from nearest well-l�j'�'_jQ - rJ r� q l_V_-___._-_.Mat ial_._ i..- .__...___�_(___c^__ No. of compartments_-_--_151-_.r-___--Size_C_�_.._x__s.1_xi. Liquid dgpfh._-.... '___.__...Capacity....�7.cz C g T� Distance from foundation!}t.�y__ __ ' Dispos I Field: Distance from nearest welld_�-_ ___ �i CY�____-Distance to nearest lot line _T�J-_-_.... .� Number of lines--------- -�_.-p Length of each line-__._-_._. _U rf____-Width of trench___...__ _ _� Type of filter materi ..._ -=1�t�Tr"�epth of filter material______,<__$_--_-.__Total length--______�_ Q__._-__-__--____-. Seepage Pit: Distance to nearest well----------------------Distance from foundation----.-----------Distance to nearest lot line------.......... r 11Number of pits.---------------------Lining material-----------------------Size: Diameter-----------_--------_Depth._-..._.---_------........... 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--------------------------------------------------------------------------------------------------------------------------- L Remodeling and/or r pairing (des ibe):__..____.__ i `. _X_3J X` ------------ — 9 sem ..... ... - - - - -- - -- - ------------------------------------------------------- --- - ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- - I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin Coun L ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. A4-.---.------------------------------------------(Owner and/or Confracto - - By°-- - -- ----- ------- (T 1 -----------------------------------... ------------------- 1+1e -------- --------- -- ........ ._. L (Plot plan, showing size of lot, location of system in relation to wells, buildings, at c., can be placed on reverse side). e FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY._ -._._ ____._. .-.- DATE s�f'------------------------------------------- REVIEWEDBY.----------------------------------- ------- -------------------------------------------- --- DATE------ BUILDING-PERMIT ISSUED: --- ------------- DATE-------_—�`- - - - -------------- L .z - - - -- Alterations and/or recommendations: Lr3.�c a ✓---------------------------------------------------- .................... ..._---- - ---------------------------------------------------------------- --------------------------------------- --------------......------- -------------------------------- --------------------------•-------------------------------------•----------------------------------------------------------------------------------------------------------------------------------------------- V ------------------------------ - ------------------ -- ------------------------ --------------- be ----------------------------- ------- - �-------------------------------------------------- 91 ---------------- ------------------------------- 91S FINAL INSPECTION Date-- ------- - - be 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 8-51 Revised W-2100 -