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LICATION FOR SANITATIONPEIT Permit No. ./.... __-__.3 �I (Complete in Duplicate) t /31./ C; ' Date Issued ------- Application is hereby made to the San Joaquin Local Health District fora permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. 41t JOB ADDRESS AND LOCATION _ Owner's Name----------� -- •------------------------'--------------------------------------------V- ----------- Phbne------------------------------------ Address -- Contractor's Name_______________________ ; - -- - --•---- - - -- ------------------------• -----•----------J-----------------------.=--�"Phone----------------------------------• Installation will serve: Residence Wpartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: .... Number of bedrooms __ Number of baths �Lot sizeLO�_�Oe+P-Q0____________--------- : Water Supply: Public system ❑ Community system ❑ Private depth to Wa#.er Table'44�. t. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay L06a'm ❑' Clay ❑ Adobe 94000HO07rdpan 0, Previous Application Made: Yes ❑ No Ugo "New Construction: Yes ❑ No P__1`k/VA: Yes ❑ No fir—' TYPE OF INSTALLATION AND SPECIFICATIONS: ' (No septic tank or'cessp6 I �rmitted,if public sewer is available within 200 feet.) W.Se tic Tan Distan`ce`tk neereesf well______--._____'Distance from foundation_____ __ ---------Material___________..__:__________-____..______________.. n a a � No. of cor 'rtments------=------------•-----"Size.....---..------------------•---Li xlepth--•-------- 2 apacitY----------------------- Di�sp s I Field: ��istance from nacest well__ ____."_.Distance from foundation___ ._ �._____ 6,�d' to crest lot line---r� ______-_.. i �'f -A ff�'Numb�r of lines_______ ___ _____________'f ength of each line------J _,_�_Pf'Width of trench___, .- �� ------------ Type of filter material_ ..X#� E th of filter material___ �� - - - p - - ----------Total length-------� �L'"s1'�-------•-- �. ' ' �� XJW7y . Seepage Pit: Distance to nearest well-,VV ------ f om foundat' n �_---__.Distance to nearest to ine____ *_ Number-of s_-f.___,.._. i___Lining matenal_:1 19 : D ameter- ..6_______Depth___!-.- ------------ Cesspool: Distance from nearest well-------_-------I Distance from foundatio _________-___.____.Lining material----------------------------.________ ❑ Size: Diameter------------------------------------Depth----------------- •--- ,---------------------Liquid Capacity----------------------------gals. W Privy: Distance from nearest well_______________I-------_____.--------------------Distance from nearest building-___-____________________________________- Distance to nearest lot line________)________________ Remodeling and/or repairing (describe):------------- --------------------------------------------- -------------------------------------------_------------------------ ___ 1 !-« ________I ____________________________ ________________________________________________________ -_-..........___.______-_____-_--_--___------_______--_-___-__-.____...-__..,-......____------------------------------- t , hereby certify that 1 have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, nd rules andguI tions of the San Joaquin Local Health District. (Si ned 7{ 9 I---------- € �(�d Contractor) By:------------------•--•--••---•-••---•-- - - --------------------(Title)- R{ ------------------------------ (Plot plan, showing size of lot, location of s in.relation to wells, buildings, etc., can be placed on reverse side). T, W0 _PPPART.MENT-USE-ONLY,--_-- -W - ---�, APPLICATION ACCEPTED BY----------__1 �� -k -- s------'-----------=`--------------------------------------•---------------- DATE-----�-----•��--�-�---J�-�---------------------------- •' REVIEWEDBY------------------------------------------------------------------- ------------------------------------------------------. DATE--------•----_------------------- -- BUILDING PERMIT ISSUED------------------------------------------------=------------------------------------•--,--••-- - DATE----------------------------- Alterations and/or recommendations:----------_ rA!AU ---------Z .30----�.M_ 0' 175/7.._--T.R_Q:---- �'rr b�T.-T-H--------- �4 -=----------- % 'M -------•-•----------------------- -r -- ---- -----•------------------------------------------------------- ------------------------------------- ` �14 ---'•----------------------------------- --`------- 1 FINAL INSPECTION"' ,,_ _ - - - - -----------------•5----- ------- Date_ 7--L-5-7- - SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 We14 6ak,,4fre'kf. ,q. `. ' 3MI Syca o Street 814 North "C" Street Stockton, California Lodi, California N. ° Mantel Z a ifornia Tracy, California ES-9-2M , Revised 1.57 F.P.CO-