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_47fF17 11 -Gs OR SANITATION PERMIT Permit No. APPLICATION, ....... (Complete in Duplicate) Date Issued Applica4-ion is hereby made to the San Joaquin Local Health District for apermit to construct and install the work herein described. This application is made in compliance wit C5unty Ordinance No 549. JOB ADDRESS AND LOCATION... . .............. ------------------------------------------------ wrier's ---- ---------- ----------------I---------- 2#D Name....4;::2 ----------- Phone.-- ------- ---------------------- Address_.____2_3--- -------------------------------------------7------------------------------------------------- ---------- 111 Contractor's Name_------ -- ------------------------ --------------------------------------------------------------- Phone:-------------------------- -•---- it Installation will serve: Residence Apartment House [] Commercial E] Trailer Court E] Motel ❑ Other E] Number of living units: J--- Number of bedrooms __.9L Number of baths --Z,- Lot size _11.-or----X 1__Z`4_____________________- Water -4------------------------- Water Supply: Public system 9--e-01mmunify system E] Private [-] Depth to Water Table X_Pff. Character of soil to a depth of 3 feet: Sand F] Gravel 0 Sandy Loam F] Clay Loam E] Clay 0 Adobe 6--ra—rdpan E] Previous Application Made: Yes ❑ No --blew Construction: Ye TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well-420--c-_Distance from foundation__._ --_-.Material__________.______ -------- No. of compartmerifs... I--..... -—---------- Liquid depth---0---44- ------------Capacity---(;,kaq------ Disposal Field: Distance from nearest weIlii2oj.*w_n___Disfance from foundation____ _Distance to nearest lot line------ Number of lines--_.____-7-- -1------Length of each line------ZJ7--------- --Width of trench.___-4--¢__f---------------� UL --------- -- Type of filter material___J —-- -----_-Depth of filter material------I-&---------Total length ip---------------------- Seepage Pit: Distance to nearest welll:�_�.. -- --____Distance from foundation....45/ ----- Distance to nearest lot line__./!P------ D r Number of pits____...._________Lining maferial_)56%~�--..Size: Diameter.-31-.---- -----Depth-_-4-49---------------------- -tjc;" Cesspool: Distance fi-om"nearest well-----------------Distance from foundation------------- ----- Lining material___._..____________.__. ❑ aterial-----------------------0 Size: Diameter--- ------------------ ---------------Dept h----------------------------------------------------Liquid Capacity---------------------------gals.em Privy: Distance from nearest well...... ------------------------- --------- - --Distance from nearest building_.__-_____.__._._____--_____________..___. ❑ Distance uilding-._------------------------------------- Distance to nearest lot line----------------------------------------------------------------------------- Remodeling and/or repairing (describe):--------------------------------------------------------------------------------------------------------------- --------------------------------------- ---------------------------------------------------------------------------------------------------------------------------•---------------------------- ------- --------- ---------------------------------------------------�. -------------------------------------------------------------------------------------------- ----------------------------------------------------------------------:----------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------- - 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)-----R04—R.10� ...... ------------_-------------------- --------------------------------------------------------------------------------_----------------------(Owner and/or Contractor) By:---4�=__Vv Ag�l-------------------- ----------------------------------------------(Title)-----------------------I--------------------------------------- (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--S-------- ---- -- ------ - - - -------•..-*-------------------------------- DATE_z_3t1-—-----_--------- --------------------------------- REVIEWEDBY----------------------------- - ........ ------------------------ ------------------------------------------ DATE__r &V , -.-------------------------------------------------- BUILDING PERMIT ISSUED------------------------------- ---------------------------------------------------------------------. DATE_ RM-------------------------------------------------- Alterations and/or recommendations:--- ------ - -- ------ ....... -------------------------------------- VN---------------------------------------------- ----------------------------- . .. - - - I--------- -.------ --------- --------------------------------------------- ----------------------------------------------------------------------------------------- ---------------------------------- ----------------------- ------------------- ------ --------- -- ----------------------------------------- -- --- ---------------- -- ---I------------------------------- ---•- --• ---- ------------- --------------------------------------------------------------------- ------------ ----------- -- ?------- -- ------------------------------------------------------ - FINALINSPECTION BY------- __----- ------- ----------------------- ------------- 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 ES-9-2M 145446 A7WOCD 12-4