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'(1J� APPLICATION FOR SANITATION PERMIT. . Permit No. (Complete in Duplicate) Date Issues! -----_/-•-- -•---.•.-• 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. 76er�CJ✓ J08 ADDRESS AND LOCATION = -'-------�'------- =�=_ = = 5.�1a_,.t_ 0- � 1��_�.t,�_�=a/ r Owner's Name ?' 6 � ['� ±_x _ ►. 1 ----- ------------------------- ------------------ Phone_..:-------------- ...... Address--------------- ------------------------_--- C ------=----------------_-- Contractor's Name----- iPrd-=------� prJTe J% Installation will serve: Residence-a-'OA"partment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ - Number of living units: ___ ___ Number of bedrooms=___Number of baths Lot size __.____-__--------•_ Water Supply: Public system ❑ Community system f❑ "Private [�I:Septh to Water"Table --_____ ft. ! Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ .Sandy Loam ❑�`�Clay Loam ❑ Clay ❑ Adobe [jjardpan ❑ Previous Application Made: Yes ❑ No D_-New Construction: Yes ❑, NcFHA/VA: Yes ❑ No 0--' TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) Septic: D�sNo{ of tom artmentsance from {__w�_��_, n Dzeance�fr from �atiL q� depth__yre��l_-G GC 13 !' t C.jt_ ❑ _ P pacifyS�-------------- D Q ------- ' Disposal FieJd: Distance from nearest well50_�f-__-_Distance from foundation.-J_v_�_____Distance to nearest lot line_ --__�_. ❑,� Number of lines-----------I-------------- -------Length of each line--_---:_AO__0 -- --.Width 6f-trench - f--�'------ P g — >. an Total ?lengthU --------- ••---- See a e Pit: . . Dis#ante to nearest well______--------------------Distance from 'foundati Y P. a-- P ___r/._.__:_.Qistanee to nearest lot line________________ e a iter materia __-_� �"..___De Depth of filter material.--./.�___ ❑ Number. of pits---"-------------- -Lining material-----------------------Size: Diameter------------------------Dept h-------:----_---------- ---------- Cesspool: Distance from nearest well-----------------Distance from foundation.-._:______-__ Lining material--------------------------,-_________- ElSize: Diameter------------------ --- ---------------Depth----------------------------------------------------Liquid Capacity-------- ---------gals. Privy: Distance from nearest well--------------------------- -------- -------------Distance from nearest building_______.___-__.___ ._____.._____. ❑ Distance-to-nearest lot line-----—------------^------------------------------------------------------ - l Remodeling and/or repairing (describe):---------7i /. ____s_ _ti�I[ p_ -7 ' ' _- - S- .c•�` __.r,..-------A.1---a` -- ---F! /?------C a en, -0- 42- '`� S Iv�Qua!✓ I r,,75(' ,. - ---------------------------- ----------------------- ---------------••----------------------------------------------------------------------•---------•-------------------- --------•------------- ------------- I hereby certify that I have prepared this application and that the work will be done in accordance with-San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. AO-Ta re (Signed) �- - ---i (Owner and/or Contractor) By:-------•-------- '!^ !. ..... —---<�_'- --- ----- ---------------------------------(Title)----- {,` =�-x•------------ [Plot plan, showing[ of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------- - ----1------------- - -•---•------------------------ �� REVIEWED BY--------------------------- -=---------- - --- -- --- --------------------------------- - DATE____-------- •------•-•----- BUILDING PERMIT ISSUED---------------------------- •----------- ------------=- ---------------------------------------------- DATE--------------- Alteretions and/or recommendations---------- ---------=----------------- -•---------------------•---•-------------•--------- ----------------------•--------------[--------•-------•---•--------------------------------------------------•-------------'--------------------------------•-----•----------•-----•---------------------•---------•---•--•--- FINAL INSPECTION BY:--____ _ __-- ` --- ilfl�'1 �,�- Date (( ------------••-----••---------- 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 E5-9-2M Revised 1.57 F-P.CO. 5