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Permit No. -"- ----------------- APPLICATION FOR SANITATION PERMIT / (Complete in Duplicate) Date Issued ---- 'd -— J-- d. Applica+ion is hereby 'made to the Son Joaquin Local Health District for a permit to construct an in 'stall the�NOC � n"dr � � This application is made in compliarice with County Ordinance N°. 549. p/ � ---•-- F JOB ADDRESS AND LOCATlON i F7r �° i „�'�� ------------------------ ----------- --- ---...... -------- ------ hone.----- --•----------------------•--- -- - Owner's Nam -------•--- ------------- --- �------- ------------------------------------------"----- Address ! ----- 1-- / fi.J - n�cr�- e. ------------ Phone Name_________.p��------ --- -� _ Installation will serve-. Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court D Motel ❑ Other Number of,living units: __/____ Number of bedrooms __� Number of baths Lot Sof A----- #d�i ec-5-•-----•-------- ' I Private Depth to Water Tal Water f+- Water Supply: Public system ❑ Community system ❑ Adobe❑ Hardpan ❑ i s i; Clay Loam Clay ❑ Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Lo�PN 1; ' t_,n,/ Previous Application Made: Yes ❑ No New Construction: .Yeso ❑ v r , T T - TYPE OF INSTALLATION AND SPECIFICATIONS: � (No septic tank or cesspool permitted if public ewer is available within ZOU feet.)f 13tz!C-/C" v . - -- Septic T nk: Distanie #rem nearest w Vi-_��__---"--Distance KS x� Liquid depth--- --------------Capacity..¢'�.Qdd------- /� `'No, of compartmentgN_,,.:.,�__.___ -_ Size_.- r r -• _. f Q_�____-Distance to nearest lot•lino- -------- pisposal field: *Distance from nearest well___ Q©._._Distance from foundation____q� ' ---Length of each line----A- - _r- -----Width of trench----c ----------- Number of lines-__ __.�"---- - -- g / r cc ,�*+'��,,��_De th of filter material__---- ------------Total length---/301 t oT filter material [ /.IVB p Distance to nearest well Q..___._FDjsfance from foundation __.__:Distance to nearest loft Gne_��"_--.---- i See pag it: � _ C IciK+ .3 .Depth-----oz -------------- Number'of pits._" ------------Lining ma#erial., ___a ----- -.Size: Diameter__. Cesspool: Distance from nearest well---------------__Distance from foundation.___.--------------Lining material__-_____._____- als. ' -------- --------------Liquid Capacity-- Size: Diameter_---= ---------- -------------- De ❑ -' •71 g --Distance from nearest building------------------------------------------ Privy: Distance. from nearest well__----------------------- Distance to nearest lot-.line..____.__."s"""--- -- ---------------------- El ^`ll { i Remodeling and/or repairing (describe):___-------"----- - --- i •---------•-- ------•--------------------------- ------------`•---------------- ---- rt �- l --•---- -------------------------------------------------------------------- ------- --------------------------- 1 - --`-----------------------------------•------•---••------•`---------•------------------------------• -- I hereby cer+if t at I have pared this ap ication and th t the work will be done in accordance with San Joaquin County ordinances, Stat a , and rul nd regulation - the San Jo uin Local Health District. Si ned ----------------- -- ---___ wrier and/or Contractor) - ---- - ------ - - ---- ( 9 ------- -------------------------- _.._(Title) ------------ (Plot pla owing size of lot, location of system in relafio o wells, buildings, etc., can be p aced on reverse si e. } FOR DEPARTMENT USE ONLY l ` DATE---------•-- APPLICATION ACCEPTED BY----------------------------- ' ,• DATE------ --• 1-9 ----- REVIEWED BY-------------------------- ' s`{� . BUILDING PERMIT ISSUED.-----'---------- - / -"" - - Alterations and/or recommendations:-'=:!-'"----Z-- a Y - ----------- . ._ t ti V --. f = _ __ ...._ W E �^ ` `n-'-•� - Date_ - • - •---••----•----- FINAL INSPECTION 'BY:_ . .. .. . .."-------------------------- - --------------------------------- - -- I I SAN JOAQUIN LOCAL HEALTH DISTRICT l32 Sycamore Street 814 North "C" Street 130 South American Street ! 300 West Oak Street Trac California Stockton, California I Lodi, California Manteca, California Y. ES-9-2M 145446 ATWD13D 12-54