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APPLICATION FOR SANITATION PERMIT Permit No.,9-7--7--r-----•- f ' � {Complete in Duplicate) Date issued i Ccation is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein'described. hPsapplicatian is made in compliance with County Ordinance No. 549. � JOB ADDRESS AND LOCATION._-- ------- - ..,,------------------, wit ------------- P}ione__��;�_'+�--�- ------------ M ----------------- Owner's Name---- 1' li. ---------------------------------------- ----------------------- 1 % Address- ---------------- �3.4i------- ---- .------ Phone-- U_. 1 Contractor's Name------- A---- A Apartment House [] Commercial Trailer Court ❑ Motel ❑ Other El Installation will serve: Residence ❑ p i Number of living units: `�_ Number of bedrooms _rn_ Number of baths '7___ Lot size ----- _-- Communit system '❑ Private ❑ Depth to Water Table -------- ft. Water Supply: Public system ® Y Y Hardpan C1Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam F1 Clay Loam ❑ Clay ❑ Adobe ❑ Previous Application Made: Yes ❑ No ❑ New Construction: Yes ❑ No ❑ �} TYPE OF INSTALLATION AND SPECIFICATIONS: O (No septic tank or cesspool permitted if public sewer is available within 200 feet.) 1� lit- -----Matrial;---,5— --�'c�» '�p-Qd-- I Septic Tank: Distance from nearest well__ hP�- Distance from foundation------ No. of compartments As¢�t -+ cr✓, ,5sze__ _ 1� �riq----------.Liquid depth-----f�a---t°� Ca acct ---+ --------=--� y [Er Disposal field: Distance from nearest wel Denath offrom each I ne foundation - -----Widthtofttrenchest lot l ine _ ---_---- Number. of lines----------------------= - g r� -------•--- Type of filter materia4. _ pepth of filter material______)1___-____Total length Pit: Distance to nearest well____________________Distance from foundation-------------------- Number to nearest lot Line-_______"_______. ❑ Number of pits_____- "___----:__---Lining material.____________ --------Size: Diameter------------------------Depth--------------------------------- Distance from nearest well-----------------Distance from foundation_ ____-----------L Lining d Capacitygals. Cesspool: --------------------------• i ❑ Size: Diameter------------------------" Depth q I Privy: Distance from nearest well___.---__------------------------------------ Distance 'from nearest building____"____------------------------------ - Distance to nearest ]of line------- --------- --------- --------------------------------------- •--------------------------------•--•------------- �Pft. C. r J'f�^T�- . A1.I. r Remodeling and/or repairing (describe):___1�a -� _ _ ® AR� F EK�. O-_-- N4-q-------------- ----------------------•--------- --------------------------------- hereby cern fy.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]_ _.�- -�--� '-------- - ------------------------------ - :-___-"___{Owner and/or Contractor _-------- -------------- }----- ----------------------------------- By:------------------------------------------ __ _"-'"�_-'------=-------------------- ------{Title)------G__,d _+---------------- [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 ---------------------------------- --------------------------- DATE------------ / ------------------- APPLICATION ACCEPTED BY ------ DATE-----------------------------------------------•------------ I REVIEWED BY------------------------------------- --------------------------------- - -------------------------- - -------------------- BUILDING PERMIT ISSUED--------------------------------------------------------------- ------------------ ----------------------------- ------------------------------ -------- Alterations and/or r co mendations: T,v�,,r� ,�j --•----------------------- ------- ----------------------------------------------------------------------------------- --------------------------- ---------------- --------------------------- Date._" t ---------------------------- FINAL INSPECTION B -------------------- y SAN JOAQUIN LOCAL HEALTH DISTRICT i 132 Sycamore Street 814 North "C" Street 300 West Oak Street Tracy, California I � 130.South American Street Manteca, California Stockton, California Lodi, California t ES--9-2M 8-51 Revised W-2100