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APPLICATION FOR SANITATION P74T MIy j Permit No. __.6---ire_ (Complete in Duplicate) / Date Issued --- Applica{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. JOB ADDRESS AV LOCAT ON:_-_ - _Ao-------- -------o5d Owner's -----------------------I--------------------------------------- Name-4 t4 x * x-�J = -------- ------ Ph - ------- one.- , Adddressss---- a-------- „ x -----------------------••-•--- --------7---•-------------------------------------Contractor's Name-----�i �� '::-----° �---° a- "� � - -------- ------- ----- -...__ Phone'R_�...:;... _ Installation will serve: Residence flpartment House Commercial # g � - ❑ Trailer Court ❑ MotelR❑ Other ❑ Number of living units: _ --- Number of bedrooms - '- Number of baths Lot size ----- Water Supply: Public system Z&oCommunity system ❑ Private ❑ Depth to Water Table _ _:' ft.• t Character of soil to a depth of 3 feet: Sand ❑ ,Gravel ❑ Sandy Loam ❑ Clay Loam ❑ ,,Clay ❑ ;Adobe. ia'rd 'an ❑ Previous Application Made: Yes 4 No ❑ New Construction: Yes '°❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Tank: Distance from nearest wellDistance stance from foundation__-_._ Septic -------------Material--------- -----------------•---•--- - ,,, No. of compartments.._-___._ _ ---=----Size--------------------------------Liquid depth--------- ---------------Capacity------------------ L g r DisposalField: Distance from nearest well;.��---Distance from foundation._-_ _____ __....Distance to nearest lot line.;_-"--__-- Number or lines___._"-._ _.__ ----/•- f Le Depth of filter material �= Width of trench__, -� ,_----.- -_ __ en th of each line___. Type of filter material----- _- -- -------------- p Total length ------------------------- Seepage Pit: Distance to nearest well_.________-.._ ._ __ ___Distance from foundation-----------___------Distance to nearest lot line----------------- .- i Number of pits_____________________Lining material-_-- Size: Diameter ----Depth--------------------------------- Cesspool: Distance from nearest well_________________Distance from foundation...__._..._.______. Lining material_____-.....___._.____.____ ❑ Size: Diameter F ------Depth----•----------------------------------------- -----Liquid Capacity_.' •----•-----------.-_gais. V Privy: Distance. from nearest well-'.__. _---Distance from nearest building --------------------------------- ^" ❑ Distance to nearest loft line-------------""__-.-.---•_ ---------- -- ------------ Remodeling and/or repairing (descrihe)------------------------ \� --------•--------- ._ ' V' ----------------------- --- ---------•----------------------------------------------------------------------•-------•--------•-•-----•----•--------•----- -------------------------------------------------------------- I hereby certify that I have prepared #his application and that the work will be done in accordance with San-Joaquin Gounty ordinancesA4& , State laws, and rules and regulations of the San Joaquin Local Health District. (Signed}_ - I 4 _ d -- vrnar r ontractor) By:... ----------------------------------------- = (Title) ., '.. .. (Piot 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------------ REVIEWED _-- , --- ------ DAT T_� ---------- ---------------------------------------- IEWED BY --- - -- DATE--- --------- BUILDING PERMIT -------------------------- Pl=RM17 ISSUED - DATE ------- Alterations and/or recommendations:.. ___-.__...___-__-. --------------------•----....------ •------------------ FINAL INSPECTION BY:....�5,0 f............_- -- 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 745446 a7wpao 72'54