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V. 1 ,5 APPLICATION FOR SANITATION .PERMIT Permit No. 77 �, I (Complete in Duplicate Cacc! { v Date Issued /_6 :,3 Application is hereby made to the San Joaquin Local Health District for a permit to construct and nstal9 2 k herein described. This application is made in Co Ila ce with County Ordinance o. 549. JOB ADDRESS AND -OCATIO ---- Owner s Address......... ° -� ne-- -- Contractor's Name. -------- ---- I -'C --•--- Phone. Installation will serve: Residence parfinent House S Commercial ❑ Motel ❑ Trailer Court ❑ Other ❑ i Number of living units: _/___ Number of bedrooms__. Number of baths _�___ Lot size ��-�-------------- I Wafer Supply: Public system ❑ Community system ❑ Private Depth to Water Tabl��f ft. Character of soil to a depth of 3 fee Sand ❑ Gravel ❑ 'Sandy\Loam ❑ Clay Loam ❑ Clay ❑ Adobe - Hardpan ❑ Previous Application Made: Yes ❑ No New Construction: Yes No ❑ r/ N." TYPE OF INSTALLATION AND SPECIFICATIONS: , (No septic tank er cssFooF`permifted�if'pub7ic sewer is evaila6le withi n, fee Septic Tank: Distance from nearest well___07'Q....Distance from foundation___,/--------M meri I--__ No. of compartments- ,---_.----. --------.--Size...�.--r� s-Liquid depth_•_-- -._---Ca acit Dial Field: Distance from nearest well.. D--_.Distance from foundation. --_` Distance to nearest lot line__-t �! . Number of lines----------f______________ _ Len th of each line_-.____-- / I - g ��0-- ------Width of trench-------^' -------------1 Type of filter material_ ._ - ._-._ _- .__.__Depth of filter i material_.. �- -- - - length-----•---------------1-5:--1 ---- Seepage Pit: Distance to nearest well_."/ ------_Distance fr m fo dation_- 1. __`•-_-_.pistance #o nearest lot line__.---_---� Number of pits---------/----------Lining material ,---- -, °Size: Diameter__..--_----- f , ,F �-2 Deptn; ---- - esspool: Distance from nearest well_________________Distance from found-tion________-_-__.--_-_.Lining material....... .._-�` .----__----- " L ,❑ Size: Diameter -------------------- ----------Depth--------------------_-----------------------------Liquid�Capacityi_-t Privy: Distance from nearest well__ _________________.` Distance from nearest building s w` ` ❑ Distance to nearest lot line 9 F ------------------------ L!v ----------------•------------ ------------- - ---------- Remodeling and/or repairing (describe -------------------------• --- .+ ---i---------------•-------------- ■p•------- ------------------------------------- - ` ' 6 _________________________________________________________________________--------------------------------------------------------------------------------------__________________________________ ______________________ I hereby certify fha+ I have prepared this application and that the work will be done in accordance with San Joaquin County a ordinances, State laws, and rule and regul ions of the San Joaquin Local Health District. i }. f (Signed) r'! -------------------------------- --------- By-------------------- r.__..,� ``" caner re --- an /or Cont ctor} ----------(Title}- - � (Plot plan, showing size to+, location of system in relation to wells, buildings, etc., can be pltd6on reverse side)., FOR DEPARTMENT USE ONLY ---------------------------- APPLICATION ACCEPTED BY ____________________ _• - DATE----- -- ---------- ----- ---------------------------------------------; ------------- -----_-- ---- --� REVIEWED BY -------- . ---------------------------------------- - ---- -- DATE------ --------------------- UILDING PERMIT ISSUED ------------------------------------------------------- ------ DATE Alterations and/or recommendations:-._---------------------------- �= = ---------------------------------------------------------------------------------- ------------------------------- ----- --- ---------------------------•-------------------- ------------------------------------- --------------------------------------- _ __ ..�..... FINAL INSPECTION BY:-__.___-_-_ Date---- ----------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 Nor+h "C" Street Stockton, California 'k,y * Lodi, California Manteca, California Tracy, California L ES-9-2M 10-52 Revised W-2100 jo