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0� APPLICATION p� N FOR SANITATION PERMIT Permit No. (Complete in Duplicated .-9/ Date Issued -,��07__-- Application is hereby made to he 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 AND LOCATION------{-! _ y I3 - --- �- -------------------------- -- Owner's Name'_R__0-----' e-Jol--d -------------------- ----------------------------------- --------- Phone.--- ----------------------------- Address--------------------- Z F ---------•------------------Address------------•--------` s _Z9 Contractor's Name------- &---kJura - --------------------------------------------------------------------•----------•----------------------- Phone ---•Installation will will serve: Residence CK Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ___/___ Number of bedrooms ___2__ Number of baths ____I__ Lot size -------- - --- """"""__.-_."___ Wafer Supply: Public system ❑ Community system ❑ Private] Depth to Water Table Character of soil to a depth of 3 feet: Sand Gravel Sand Loam Clay Loam Clay f p ❑ ❑ Y ❑ Y ❑ y ❑ Adobe ® F-iara;�s,-, u^_, Previous Application Made: Yes ❑ No [K New Construction: Yes W No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest weII.S -�"""_Distance T foundation__._ .G'_.___.Material_____--- r •-""".-_ "` No. of compartments----------- -----------Size-----i,t`- _I ---------Liquid depth----1 �•'4- -----------Capacity---3g .------ Disposal Field: Distance from nearest well-.F?-O--------Distance from foundation____`-v-.____-_Distance to nearest lot line_-_------- 1K ___.-1K Number of lines______.______ ------------------Length of each line--------9Q_`-------- ---Width of trench----- - Type of filter mategC`-&------Depth of filter material- ._�'�L' __ �--_____._Total length....C?d--------- ------- Seepage Pit: Distance to nearest well---/Ag__ Distance from foundation _ ___-.-_ - /C.._' - I'..........Distance_ .___.Distance to nearest lot line-_._:________--. 3 ® Dumber of pits.-------I------------Lining material_------C- -�[---Size: Diameter--------- -- -""--Depth__.t`. f ----------------------fl Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining materia!__.---"____-________.___-_______,_ El Size. Diameter---------------------- --------------Depth----------------------------------- - __ 0 -----------Liquid CapaeitY------------- --------------gals.A Privy: Distance from nearest well------------------------------------------------- from nearest building-------------------------------------- 5 ❑ Distance to nearest lot lire ------------------------------ Remodeling and/or repairing (describe)---------------------------------------------------------------- --------------------------- --------------- ------------------------------------------------------------------------------------------------------------------------------ --------------------------------------------------------------------------------•------------------------------------------------------------------------------------------------------------•----------------------------- -- � ---- --------------------------------------------•-----------------------------•----------------------------------------------------------------------------------------•----•---•------------------- -------------- 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. (Signed)---- ---------- C -, ` .;" ----- J13-14[Owner and/or Contractor) By-----------------------•---------- ey , ----------------------------- ------------------- - T+tle (Plot plan, showing size of lot, location of system in relation to wells, buildings, efc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY___._-_ 1 ------- livSr ------------------------"------- DATE_------ ---------------------------- D BY---------------------------------------------- -- DATE BUILDING PERMIT ISSUED_------- - ----------------- ----------------- DATE. Alteratio s and/or recommendations._ �, ;.c f - ------_---_ -------------------:::::---------------------------I----------:-----------------_..- __________________________ ---_____________ ______________ -- ._ FINAL INSPECTION BY ---- ----•---- Date----------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Sfreat 132 Sycamore Sfreef 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9--2M , Revises 1.57.F.P Co.