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�:. APPLICATION FOR SANITATION PERMIT Permit i. (Complete in Duplicate) Date Issued f- - 1 1 made to the San Joaquin Local Health Disfrict for a permit to construct and install the work herein described. Application is hereby This application is made m compliance with County Ordinance No. 549. i 1."-C -------=---------------------------------- ---------------------- JOB ADDRESS AND LOCATION--:__-- e___ � y--a-144Z--------- 17, Owner s Name----- -----------------------------•-- -�`- Z.�_�;'T ,--- ----------------••-------------------••----------------------------- ---------- -------------------------- ------ Address_...------•• -- - Phone-------�?-- 1°p ------ - --- ---- --------- - - - Contrac#or's ame_____________________________ " Other ❑ Installation will serve: Residence Eg Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ J 3-- ! s- Lot size ---- 1---- ---- -- Number of living units: __ ._"__ Number of bedrooms Number of-bath Q ft. Private t Depth to Water Table _ _- Water Supply: Public system'' Community system ❑❑ ❑ Cla Liam El Clay ❑ Adobe® Hardpan ❑ Character of soil to a depth of 3 feet: Sand ❑ Gravel Sand LoamI i NiNew Construction: Ye %-:,Ng-U,� Previous Application Made: Yes ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic Tank or cesspool permitted if public sewer is available within 200 feet.)r l I%3b-_ iquid depth Capacity_e�_ Ov--`' , Septic Tank: Distance from nearest well_:o.- ____-_Distance from foundation__-�_�----- ---.Material_-------A ----------------�`--�� size--!:------ I s No. of,co,mpartrnents-- ------ -- ---- ---- � �o.. �� O Distance to nearest blot line__- ----••- f _ i. ti Disposa171 1c�i""""""Distance from nearest wei} [�_-_ Distance from foundation-�_---.F------ ` Number of lines------- ------ Length of each line_'__,�,,F;S------ -*--------Width of trench---------- ------------ I I�E" I -Notal r.length I Type of filter material______ -_-_ -�----Depth of filte mater`al .__ _-� - I Seepage Pit? Distance to nearest well__ _0.4._.__------Distance frorrm fou~a5 ze:nDiamefer__ ance toDep1h-- lomat line------ Number of pits.._------------------Lining material_-' `-)�1---- �-• - us I Cesspool: Distance from nearest well_______-_____--Distance from foundation__ _-_ _- ------Lund C Aaficl Y "--------------------gals. p ❑ Size: Diameter------ -----------------------------Depth------------- --------- - t } Distance from Inearest well--------------------------- ----- -- ----_---Distance frm neare } 6ui,l"ding- ---------'?---- Privy: = ---------------- ---------------- ❑ -----. - , Distance to nearest lot line_----------- � . F- ---- } I'( ------i) �i------------------------ Remodeling and/or repairing (describe):-------------------------------------------- ----------- _ �-- - - -- ------- ----------------------- �. -- -_.-._ - "--'-------------------c°--------------------------------'------•---------------^----------------------- ---tT----------------"---"---___--"------------------'--"----------_----aqui-------'--- I hereby certify that I have firepared this application and that the work will be done in accordance wi#h San Joaquin County ordinances, Sta e I ws, and rules a d�regulatio s of the San Joaquin. _ al Health District. t' Contract (Signed) - -------- ------------ ------- " - (Title)--- BY: ` i (Plot plan, showing size of lot, location of,system,in relation o-wells;builds gs, etc., carr be placed on reverse side FOR DEPARTMENT USE ONLY ) ) ----------------------------------------- DATE ; i APPLICATION ACCEPTED BY- ---------------- ---------- ------------------------- DATE---''------------REVIEWED BY------------------------- - 1 BUILDING PERMIT 155UED_____.-------- ---------------------- ---•-•-----•-----•---•----------- DATE------ -------------- ----- -•--------------------- --- -••----------------- ------------- Alterations and/or recommendations:------------------------------- ----"_________._____________. ----- '-/-------------•---------------- - --•--------- ---------- ;- ------- -------------- i , ----- ---- Date---- -- :5---- - - - --- --- -------- FkNAL INSPECTION :.------- --- ------ SAN JOAQUIN LOCAL HEALTH DISTRICT 132 Sycamore Street 814 North "C" Street 130 South American Street 306 West Oak Street Lodi, California Manteca, California Tracy, California Stockton, California ES-9-2M 10-52 Revised W-2100