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1 APPLICATION FOR SANITATION PERMIT Permit No. ---6-4... . (Complete in Duplicate) Date Issued ---- � +' t District permit Applica ion is hereby made +o the San Joaquin Local Health D s nct for a pe m t to construct and 'install the work herein described. . This application is made in compliance with County Ordinance No. 549. ' JOB ADDRESS A LOC TION-...-&-P�--4)1---~---- ,D'. ------ ----------------------•------------------------------------------------------------------- , ez�E Owner's N ------ --- ----- ------------------ ---------------------------------------- Phone------------------------------------ Address---- �-- ----..,1�--�--------- + t ' Contractor's Name---------------W -`"- 4�G4it__, /�sLC. --� T--.-_' Phone. ------------ -----------------• S-`17 Installation will serve: Residence ❑ Apartment House commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ k Number of living units: a2.--- Number of bedrooms 3--- Number of baths .' -- Lot size 1. X----. Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table �d ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 2--i'lardpan ❑ Previous Application Made: Yes ❑ No Er'�'New Construction: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) I 4D�ip,sF pt cTank: Distance from nearest well____--.___-.._-Distance from foundation--------------------Material______--__------------.-No. of compartments------------ ------Size--•----------------------------Liquid depth - ------ -- ----------.-Capacity--•-------------------- aield: Distance from nearest well---7a Distance from foundation---a2,� ..----..Distance to nearest lot line----/--------_ 0� Number of lines_--.----_.j/...,.--.--'-.--- ---Length of each line------0D_- ------.Width of trench----2- .��---------------- Type of filter material--.%� Depth of filter material------_.,l-�.i Total length---.3-U--------------------------- Seepage Pit: Distance to nearest well. ------------Distance from fou_n ation_---yl�--'-- Distance to nearest lot line d-�-_ Humber of pits ._--.--- Y ![}� p Lining materialC•e� ize: Diameter Depth---r -,5-------------------- Cesspool: Distance from nearest well-----------------Distance from foundation---------------.----Lining material------------------------------------- E-1 Size: Diameter------------------------------=------Depth----------------------------- ------- -------------Liquid Capacity---------------------------gals . Privy: Distance from nearest well______________________----____-----------------Distance from nearest building-_-.---_---- _-------.--------.-. t ❑ Distance to nearest lot line -- - --------- - ------ ----------------------------------•-'----•-- . Remodeling and/or repairing (describe)------------------------ --------------------------------------------------- --------------------------------------.., I ------------------------------------••---------------------------------------- ----------------------------------------------------------------------------------------------••-•---••----------------------- ------------------------------------------------------•-------------------------------------------------...-----------------------------------------------------------------------•---------------------------------------` .'.' 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 regulations of the San Joaquin Local Health District. (Signed)------------- r , ------ - (Ow rand/or Contractor r - "BY: Q--- -� -Title)-- - ------- ------------------- in �0—we:-1 showing size of lot, location of system in j ati0n to wells, buildings, etc., caA.be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ------ - ----------------------------------------------------------- DATE------�-- ------------------------------------------- REVIEWED BY-------------------------------------------- ---- - -- ----------------------------------------------- DATE------ -- ---- BUILDING PERMIT ISSUED---•-- ------ ------ DATE------------ ----- Alterations and/or recommendations:------ ------ ---1�0.---'-—.-----------------------------------------------------------------------I- ---------------------------------------------------•-•-------------------- ----- � ---------------------------------------------------------.............................---------------------------------------------------------------------------------------------------------------------------------------- FINAL INSPECTION BY:'// -------------------------------- Date SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street.. 300 West Oak Street 132 Sycamore Street 814 North "C" Street L Stockton, California Lodi, California Manteca, California Tracy, California y � `-{9-2M 145446 ATWOOO ,12.54