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APPLICATION FOR SANITATION PERMIT Permit No. .__ _?.. _tx. (Complete in Duplicate) Date Issued l s7•- f!® -o! Applica;ion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. Thisapplication is made in com lipnce with County Ordinance No. 549, 3.3 1 m F .A-t*l-t r.! S ` Y_ c T -X7 , JOB ADDRESS AND LOCATION__Ie0Qs,rVEt l _ .sf�D /'�/9 -..0 q//l./---33 cid s 7-M!S�IN �--- ,/ r- Owner s Name_cJf/S�.C�f fc't( "�i�t---•-•�_��-- C ' l'-�s------------------ Phone. „� Address-__40V Gbh/ V 3 ! 'C�=3m[-N' C-'-x ----------------------------_--_ Contrac:tor's Name f3 f'�('{Sfi! �f��-• ------------------------------------•-- ----------------------------------••--•- Phonee�.�__...4,F�CA7------ Installation will serve: Residence ❑ Apartment House ❑ Commercial Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -------- Number of bedrooms -------- Number of baths ________ Lot size ____________________________.__ Water Supply: Public system [Community system ❑ Private ❑ Depth to Water Table .�/O_ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe M--Hardpan El Previous Application Made: Yes ❑ No B"'New Construction. Yes ❑ No 0-'-- TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.] p ---------------Liquid depth--------------------------Capacity----------------------- Septic �a j t ii Distance from nearest well------__..___.__Distance from foundation_________________ __Material____:-------------------------- No. ___--_.-_ _ -___-___.__..._- ❑�� T No. of compartments---------------------- --Size-----------•--• - --- Disposal Field: Distance from nearest well A44f -Distance from foundation__-5__d- Distance to nearest lot line-,;7� P__ [t3' Number of lines____________------------------Length of each line---------- 5 !_._.Width of french_._.__�_`�______-___.._-_____.-- Type or filter material___ -�54?Depth of filter material------ length__________-7s,S_. ,___'__________________ �j I SeepacLe�Pit: Distance to nearest well____LY_Q_n�Distance from foundation..._.9v . .___.DistanV to nearest lot line--- ( ' Number of pits--------/-- ----------Lining material__ "�_ '__.Size: Diameter____---7--------Dept h------�_-s��_________.___. 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;______.___.__________________.________- i ❑ Distance to nearest lot line---------------------------- ------------------- ------------- �~ -- r Remodeling and/or repairing (describe):----��j /_��_C V.&.......-�t �� ...! .-•-... „.............. ----------------------------------- ------ ------------------------•••------- ---------------------------------------------------•---•--------------------------•---------------•-------------------- - I (hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State s, and rules and regulations of the San Joaquin Local Health District. i('�I S 7i-- --`- ----- --- --- caner and/or Contractor (Signed} -----F--------------------- - j` CrC-� -_-�` (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 APPLICATIONACCEPTED BY-------------------------------- i -------------------------------------------------- DATE--------�-------------------------------------------- REVIEWED BY----------------------------------- -----------------------� DATE---------:- _ _ BUILDINGPERMIT ISSUED---------------------- -------------- - — --- -------------------------- - DATE ---------- Alteralions and/or recommendations:------------------- � -'- --------------------------•- ------- = ------- ----------- ----- j --------------- ------------------- - %-. -- -----------_--------------------:---------------------------------------------------------------------------------------------------------------------------------------•--------------------------------------- FINALINSPECTION BY:----- -------------------------------•-•---- Date_----�- - --------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1310 South American Street 300 Wast Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California E5-9-2m 145446 ATWOOP 12-54