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APPLICATION FOR SANITATIONq PERMIT Permit No. .___7.1-___---D._ {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 AND LOCATION..-- ---------------------------------------- ------ Owner's Na ev-------- L 4 ' '-� /c -- ------------------------- - ........------------------------------- Phone------------------------------------ Address yf .----- ----•-1 ,/C� T p N --------------• ---- Contractor's Name /_A_./ ��' yd G -- Phone.. --------------------- ----- Installation will serve: Residence [&l"Apartment House E] Commercial E] Trailer Court ❑ Motel L1 Other 171Number of living units: ___j-" Number of bedrooms _7_ Number of baths - ._ Lot size ---Z5,/ O G - ------ ---------- Water Supply: Public system ❑ Community system ❑ Private Depth'to Water Table -i_.P ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam[] Clay ❑ Adobe{j-Hardpan ❑ Previous Application Made: Yes Ep- No ❑ New Construction: Yes �o ❑ TYPE OF INSTALLATION AND .SPECIFICATIONS: i {No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well---aj.d__---Distance from foundation--.--.�d /- ------ .Material--- _�!/ C ------------------ ®� No. of compartments -{-_W-- ---Liquid depth------6. ••------_--Capacity-._J7 ,00 p Size-- ---- ------------- Disposal Field: Distance from nearest well--- Gs `._Distance from foundation-----�0.........Distance to nearest lot line---..l-5 _/_-- [}�r Number of lines---------- .3-j ----------Length of each line--; .d.-_7s"-_Ls.Width of french__- _._"------"-.- Type of filter material-_-." --s'R'Depth of f•:lter*material--..._!0``___".Total length--__e- p Seepage Pit: Distance to nearest well----------------------Distance from foundation.------�_--.:'--.-.Distance to nearest lot line------ ---------- 171 Number of its---------------- - ---Linin material--------------- --------Size: Diameter---.-----------_--,-___Depth------------g ----------- Cess ool: Distance from nearest well-----------._.__:_Distance.,from foundation......'__..-=:. .Lining material-------------.-----------------------El Size: Diame#er .._-- -- Depth-------------- -------•---------------------- -------Liquid Capacity---------------------------gals. Privy: Distance from nearest well----------------'._.----_ -- _-_.----Distance from nearest building ❑ Distance to nearest lot line. -----'--------f.-.-:----------------------------------- ---•-----------•--------------- --------------------- , :.---------•-------•------------- Remodeling and/or repairing (describev6---_------Q_, ----- G_- ----: 1 f7C e .. --------•------------------------- ----------- •---------------------•---• ---------•------------------------------- ---------------------------------------.-.-------------------•---------•------_ 4---"-----------------•--------•---•---•------------------------ --------------•-•-------- ---- •-----------------•--------•------------------------•-------------------------------•------ -----------••-----•--------•---•-----------------•-=-------------------------••----------- ------ -- I hereby certify that•I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Statws, and rules and regulations of the San Joaquin Local Health District. (Signed)........ -Ie 5 --G-- 1 ------ weer and/or Contractor) 13y:.- - R---------- - ---------------------------------------[Titlel--- 4 --_1 --------------- --------- - - - --------- (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----. --�./..- DATE. y" � , --- REVIEWED BY.- ------------------------------------ DATE------- % BUILDING PERMIT ISSUED. - ----------------------------------- ----------- --------------•-------------- DATE--------- Alterations and/or recommendations:---------- ---------------------- ----------- ` , FINAL INSPECTION BY:. c -------------- -- -------= Date.-.._ l__. - ----------------- --------------------------------- 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 145446 a-rw000