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rUX .Ut-rlcL USE: a -�b-�---------- - -------- \ -_---.__-_--_______________________. APPLICATION FOR SANITATION PERMIT Permit No. .. .Q�-_g 3 7 -------------------------------------------------------- (Complete in Duplicate) 2� 19 . This Permit Expires 1 Year From Date Issued Date issued .................... Application 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 A LOCATION._�--� �C/ L-L�- - - Owner's Name _st55= -- _ _ _rS C° --------------------- --------------------------------------------- Phone--------------------------------•--- Address----- nv om 14- Contractor's Name,.. ;A•�TCCq ��j� ��_1�1K ��T\1�jt�C� Phone Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of livingunits: __ _____ Number of bedrooms .-__ Number of baths __ .___ Lot size ______ _________ _ - --___._.____________... f .--- Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table,0 f Character of soil to a depth of 3 feet: Sand E] Gravel C] Sandy Loam E] Clay Loam -] lay El Adobe ardpan ❑ Previous Application Made: [If yes,date-.----..-- �/� ---1 No ew Construction: Yes No ❑ FHA/VA: Yes [rNo ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) = y� 10-•------.Material. E�`>1 4— septic T ! Distance from nearest well__S�,- Qis#a a from foundation____ [ No. of compartments---_____ .__Size__ [. x_ .Q___._Liquid depth______ ___________.-.___Capri .. 0O ----------- Disposal Field: Distance from nearest weIIJ_____Distance from foundation-_l _' ___, istance to n Brest lot link_________ ______ U Number of lines---------�.1�________________Length-of-each line______5t0_�_ .--------Width of trent``. Q.`_'.--.-- --.-•-- W Type of filter material___ a - ( -----Depth of filter material______ _-____-Total length----/'�_ _________________________ { Seepage Pit: Distance to nearest well-------___------------Distance from foundation--------------------Distance to nearest lot line......._.________ \ ❑ Number of pits__________________ __Lining material-----------------------Size: Diameter_____-.______-__.___---Depth___._---..--__-_____._________-- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material--------.___-_________________--.--_-. ❑ Size: Diameter-------------------------------------Depth---------------------------------- -----------------Liquid Capacity-------------•-•------------gals' Privy: Distance from nearest well_____-__________________________________________Distance from nearest building----_-_ .------ . ❑ Distance to nearest lot line----------------- ------------------------------------------------ Remodelingand/or repairing (describe):------------------------------------------------------- --------------------------------------------------------------------------------------------- -------------I.......--•-------- , A --------------------------_---------_--------------------------------------------.---------------.---------------------------------------- ----------------4------.--------------------------------„--__-____.-.__.- I hereby ce if that I have prepare this application and that the work will be done in accordance with San Joaquin County ordinances atat ld r� r g I�7-o e-San Joaquin Lacal Health District. Sined� 9 }----- -------- ------------------------------- - ---------- - ----------------------- ---•------------------------------------------------(Owner and/or Contractor) Ely:----•--------------• ---------------------- •---------------------- ---------(Title)------------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). s FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED ---------------------------------------------•----------- DATE------- REVIEWEDBY------------------------------------------------------------------------------------------------------------------ ----------- DATE BUILDING PERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE Alterations and/or recommendations:-------------------------------------------------------------- -------------------•-••-------••--------- -------•-•------------------------------------------------•--•--------------------•--------- ------ --- -------------•------------------------------ ------ ----- -------- } ------ ' • -----------------------------•-----•-----------------•----- •---------- --------- ------------- ---- -------------------------------------------- -•-- ---------- -- `------ ------- — -----------------•-------------•-••-•---------•---------------------- ---•------------ -•-----------•---- FINAL INSPECT ON BY:.--- Date ✓ ��/ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California E9-9 REVIVED 0.59 F.P.00,2M 6.60