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/5 7 S_- APPLICATION FOR SANITATION PERMIT Permit No. (Complete'in Duplicate) g� . Date Issued _j: This is hereby made to the Son Joaquin Local Health District for a permit to construct and install the work herei!I d scribed. is application is made in compliance with County Ordinoce No. 549. 4 — % JOB ADDRESS AN¢QLOCATION-----Alyd,il_40------- -- ---- --------------------------------------------------------------ii--------------------- Owner's Name -------- _ A_ ----------------- ----------------------------------- ------------------------ Phone---7-7b/d e - - -- ---------------- -------------------------------- Address------- -------------------------------------------------------------------------------------------------------- Contractor's Name-..--- /?,al _/Pd47— ---------------------------------------------------- Phone��o -------------- Installati n will serve: Residence 0 Apartment I House El Commercial^ Trailer Court E] Motel L] Other E] Number of living units: ---------- Number of bedrooms Number of baths .------. Lot size ...... .......... Wafer Supply. Public system Community system [] Private L] Depth to Wafer Table ft. Character of soil to a depth of 3 fee+: Sand E] Gravel [-] Sandy Loam [] Clay Loam El Clay [] Adobe :Hardpan C] Previous Application Made: Yes E] No X New Construction: Ye No TYPE OF INSTALLATION AND SPECIFICATIONS: SX F-l (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank- Distance from nearest we1_1 Distance from-foundation._ op ZZ, -------Maferia --------------------- ----------- ---------- ----------- Liquid dep�h-------�/_ :P—------Capacity-IL'Fev No, of compartments Disposal Field: Distance from nearest well--- Distance from foundation----a!;�_`4....Distance to nearest lot line- --3A r Number o-i' lines-__._------/--- ---- Length' of each line--------3_4 . .........Width of french-----;�Ylll'f ---- ---------- Type of filter maferial_9_t_A_C__k_Depth of filter material------;Y"'____.TofaI length.___• .........------------------------- lop Seepage Pit: Distance to nearest well_._-_____-Distance from foundation-----4CA,---Distance to nearest lot line--- Number of pits--- -----------Lining materia 1---S-t_RR_1C1e_Size: Diameter--- 3-4.-0- Depto__..___----_1.21 " 7--------------- Jlpool: Distance from nearest we1-----------------Distance from foundation .........Lining material------------------------------- ------ 171 i Size: Mameter---------------------------------------Depth------------------------------ -- -------------------Liquid-Capacity----------------I ----------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building------ --------------1 1----------------- - El Distance to nearest lot line------------ --- -----------------------------------•-------------- i! ----------- RQmodeling and/orairing - ---—-- I---------------------- &eI ------------------- ---------------------------------------------------------------------------------------------------------------- -------- --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ---------- -------------------I-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- - I I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaq . County ordinances. State laws,' and rules and regulations of the San Joaquin Local Health District. (Signed}------------------- ---------------------------------------------------------------------------------------------------------------- ------( wner and/or Contractor) ZX-1-1—-------------------------------------------------------(Tif le)__,4L By:-------- /?, -- - ------------ (Plot plan, showing size of lot, [oca�10,2--n4,07fdY4,fern in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--'--' --------------------------------------------------------------------------------- DATE��_. ZP1--------------------------------- REVIEWED BY-------------------- -- ---------- N -------------------------------------- -------- DATE---vv—--------------- BUILDING PERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE____C:� ... ---------- ------------------------------------ Alterationsand/or recommendations:----------------------------------------------------------------------------------------------------------------------------- ------------I --------------------------------------------------------------------------------------------- ------ -----------------------------------------------------------------------------------------------------I-------------------- ------------------------------:-----------------------_---------------------------------------------------------------------------------------------------------------I--------------------------------I-- ------- --------- ---------------------------------------------------------------------------- ---------- I---------------------------------------------------------------------- ----------------------------------------- -------------------- -- ------------------------ ---------------------------- --------------------- ---------------------------------- -------------------------------------- --------------------------------------------------------- FINAL INSPECTION BY:_':----- ----------_- Date------ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814North "C" S.1 treat Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2m 10-52 Revised W-MO