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APPLICATION FOR SANITATION PERMIT Permit '0 8 (Complete in Duplicate) Date Issued�� y/sS.21 Application is hereby made to the San Joaquin Local Healt District for a permit to construct and install the work herein described. This applicafion is made in compliance with County Ordinan No. 549. JOB ADDRESS AND LOCATION-------- AA34------ - 9A/f/41 /f/4�Q------R Owner's Name-•--- ------•--------------------------- --------?4-:!----Fi L m----------------------------------------- Phone --_Qyf2------- Address...•-•-------------------------------------------- Contractors Name-------------------------- e n-:-- R►�}a�- `'E' er 1� s ! C.------- Phone----9!=,V!07------ i Installation will serve: Residence �partmenf House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: YrNumber of bedrooms 3---- Number of baths lff�Lot size --�--/-:. _�K-��++_�! Wafer Supply: Public system �ommunify system ❑ Private E] Depth to Water Table T� ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ �❑ Adobegj, Hardpan ❑ IL Previous Application Made: Yes ❑ . No 0 New Construction: Yes E] No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.)5ae c ja 4.1 Distance from nearest well_MANFA__Distance from foundafion't6l'----------Material---------------------------------------------- __ w Aj No. of compartments--------------------------Size--------------------------------Liquid depth--------------------------Capacity Disposal Field: � Distance from nearest well-----------------Distance from foundation---------------------Distance to nearest lot line----------------- M1Number of lines_`___--_--________________________Length of each line-___________-__ {' ---------------Width of #rench----------------------------------- Type ------------------------ --------Type of filter material___________I------------Depth of filter material-----------------------Total length___________---__.___.________._____-____ r Seee Pit: Distance to nearest well_AY04dV.__pistancfo ndation---- to nearest lot line________ Number of pits__________________Lining material_ _ Size:,Diameter___0_j---_- _.Depth___,r2_�_`________ --_ Cesspool: Distance _ _ _ from nearest well_____________ __Distance from foundation--__-____________ .Lining material------------------- DiameterF1 Size: ------------Depth---------------------------------------------•-----Liquid Capacity-------------------------.--gals. I Privy: Distance from nearest well-------------------------------------------------- Distance from nearest building-------------------_--.--_------------__-- ❑ Distance to nearest lot line Remodeling and/or repairing•_(describe):-------- -----------------------------------------------i-------•----- - _. ---------- ----------------------------------------- -------------------- -----------------------------------------------------------------•--------------.---------------------------.----------------------------------•-------------------------------------------------------- I hereby certify that I h reared this application and fhat the work will be done in accordance with San Joaquin County ordinances Stat la , nd ules a regulafio of the S in Local Health District. + {signed} i �f5 ------- --Q&S-.--- B /3�:r { Contractor) : - ------------------------------------------------(Title)- a51_X?']- �['1 (Plot plan, sho i size of lot, locafion of�ystem in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY I APPLICATION ACCEPTED BY------- ----- --- ----------------------------------------------- ------- DATE------------ ----� -��-_ - ---•----<----�,:,-�" �-, REVIEWEDBY-------------------------.----------- --------------- --- -------------------------- -------------- DATE------- BUILDING PERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE Alterations and/or recomrn nclafions:- ;; -------- ------- . w ----------------- ----------- -' ---------------------------------------------------------------------------------------------------------------------------------------------- ----------------------- -------- --------- --------------------------------------------------------------------------------•------------- ------------------------------------ -------------------------------- - ---------------------------------------------- -- ------------------------------------------------ ---------------------------------------------------- FINAL INSPECTION BY:-- ------ -------------------- Date----------- 5 SAN JOAQU.IN 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 - I { ES-9-2M-8-51 Revised W-2100