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t _3D APPLICATION FOR SANITATION PERMIT Permit No. _7112-_t------ (complete -"t12•'~-----(Complete in Duplicate) Date Issued -----1(__W -4 cal5- zao-D- Applica4'ion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. / 3 0 AJ, k 0.00E �' 14 -------- �� ,/�,o`-r��•�1�---- -----�"""---------- JOB ADDRESS AND LOCATION..---/. �:__ ! ----------------- --------- ---- Phone------------------------------------- Owner's Name- -- ---` ------•------ -----E---• -_ - -- ----�---- Address--- 1--4... - 3 _------------- one Contractor's Name__.--- ----------------------------------------- ------------ ---- Installation will serve: Residence g4--Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ___/_ `-- Number of bedrooms .3--- Number of baths .Z-_ Lot size __11'el 77--- -, -------------------- Water Supply: Public system Z -r-Immunity system ElPrivats ❑ Depth to Water Table _41/1/ft Character of soil to a depth of 3 feet: Sand F1 Gravel ❑ Sandy Loam ❑ Clay.Loam ❑ Clay (:1 Adobe Her ❑ Previous Application Made: Yes ❑ .[No 6--M-ew Construction: Yes TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 240 feet.) r Distance from foundation----- Matyerial-----------------------------------_------------ Septic Tank: Distance from ne11 arest well x�.__ � r, 9�_ 0� No. of compartments---- ',------- ------ 5ize_ �e -6-------- depth-�--`-1--!--- Capacity } �- GN Disposal Field: Distance from nearest well_Distance from foundation_-- i _Distance th of french neo es �hr e__ :__---- 4 Number of lines'___ _...._ .._ Length of each line------ O p1 -�--------- Total length--------- - --- ---- ---•-----•----•-- Type of filter material___- Depth of filter material__.--. _. Distance from.foundation__- -- Distance to nearest lot line__-------• + Seepage Pit: Distance to nearest well,�Lw`- "----- ---Depth__,93 -�.--`-------------- �__ Number of pits.-,----�-------Lining material- . w2 Diane#er_ Cesspool: Distance from nearest well----------------- from foundation-.........--------- Lining f ❑ - mat -_-_-_9_ gals. Size: Diameter-- ----------•------- --------- -De th--------------------------- -- --------------------Liquid Capacity----------------------- Privy: Distance from nearest well______________________ _ -------------------------Distance from nearest building----------------------------- -: est lot line------------- ------------------------------------------ ❑ Distance to near ------------ i Remodeling and/or repairing (describe):------------------------------------------ ------------- ---------•------------------------- done • ordinances,l b5tatetlfawsh and rules ulespandaregulat ons olf the San Joac{uirnhL calkHealltheDistr ctn accordance with San Joaquin County 1 Contractor) Si ned ------------------ ( 9 -- -------- (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--------------------------- ------- --------------__ 58 DATE--------2 �f( _5 -------------------------- REVIREVIEWED WED BY ------------------------------------------------------ DATE------. --- _ ----- ----------...---------• __ -----------_.- ------•--------- ------------------ DATE-- ---------------------------------------------•----------rF BUILDING PERMIT ISSUED------------------------------- ' Alterations and/or recommendations---------------------- ---------- ---- --- ---f -------------------------- ----------•------_-_...-------------•-•---- p ---------------- 6 Ge ------- ------ --- ---------- ------ - --------- ------------•------------ Date FINAL INSPECTION 'BY:_______. - ----- T ------------•---•-- SAN JOAQUIN LOCAL HEALTH DISTRICT 132 S camore Street 814 North "C" Street 130 South American Street 300 West Oak Street y Trac California Stock+on, California Lodi, California Manteca, California y. ES-y-ZM 145446 A- 30D 12-54