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.-f-_�C___- ��, APPLICATION FOR SANITATION PERMIT Permit No, .-.,2f--7--- 1 �l D (Complete in Duplicate) Date Issued Applica-%n is hereby made to the San Joaquin Local Health District for a permit to construct and install the work heresn described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION-----------17-.0 .1-1)------ - /� ------ ------ -------------------------------------------------------------- Owner's Name----------- --- ----/-----`--------- ------ ------ -------- - -------------- ---- - -------------= ---- ------- .-.-. Phone-----------------------------•-- Address Va A. ......----- t Contractor's Name-------- 4V------PC T - `'''a- "--•----------------------------------------- Phone----------------------------------- Installation will serve: Residence E9_Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units:-._- Number of bedrooms ._ - Number of baths .-1---- Lot size ____�7..�` A-_l.Q-1.)---------------------- Water Supply: Public system S- Community system ❑ Private ❑ Depth to Water Table .k ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay RL Adobe❑ Hardpan ❑ Previous Application Made: Yes ❑ No �L. New Construction: Yes Q�k No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspoolf permitted if public sewer is available within 200 feet.) p from foundation_- -Q Material_--6-C- -------------- --------------- Septic Tank: Distance from nearest well-Mn--c-Distance -----------• - No. of compartments-.-_-�---------------Size-_%�-�-�-G-Liquid depth--- -_-�D-..- It _-__.__.Capacity----F -----___ Disposal Field: Distance from nearest well/V67 .Distance from foundation-_ g.r------Distance to nearest lot lineIm Number o4 lines------------ Length of each line--------- 1------- _--.Width of trench.-- ------------------ Type of filter materiall-j5 -_ -jqr--Depth of filter material---._-Z-5f-- Total length.--__ c3_�_______________------ f a r Seepage Pit: Distance to nearest well-..�(1_.-0:?'I�_Distance from foundation----..----.�-.---.Distance to nearest lot line-- �-D--._--- Number of its--___-. . ---Linin materials.�_> -t"lze: Diameter---- _`�- --Depth..-� ^--------------- A / 9 Cesspool: Distance from nearest well----------------- from foundation.--.-- _.._Lining material----------------------- ❑ Size: Diameter--------------------- -----.Depth----------------2------------ ------Liquid Capacity------------------ -- -----gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building-------------.-----------_-_-------------. ❑ Distance to nearest lot lire---------------------- ------------------------ ----------------------• -------------------------------------------------------------------- Remodeling and/or repairing (describe):-------------------------- -----------------•--•-------------...--------------•---------------•------------•--•---••---------------.-.---------------•-- ------------------------------ ---------- •--•---------------•------------------•------------------------------------------------•--------------------------- --------------------------------------------- I hereby certifyr fii-�I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Stat ')aws.End rules and regulations of the San Joaquin Local Health District. (Signed) --'------------------------- --------- ---_!_51__7,_______-_- - - -- -- =-------------------------------- --------- -----------(Owner and/or Contractor) By=.c - -(Plot --fa G"-� (Title) (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----------- ----------------- . --------------- --------------------------- .- DATE-------- C?, ;-- BY-------------------------------------------- -- ---------- DATEe ----------------------------------- BUILDINGPERMIT ISSUED------------ ----------------- -- -- DATE------------ -�------------------------------ Alterations and/or recommendations--------------- -- --------- -- - -- ------- ------------ ------------------------------------------- _. - ------ -- - - :� ------- -------- -------- -------------------------- ------------------I-------- ---------------------_1---------------------------------- ----------- -------------------------------------- ...... -------------------------------------------------------------------------- ------ ------------------------- --------------- FINAL INSPECTION BY �'�.-v�------------------- ------ 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 E5-.9 145446 ATW006