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, APPLICATION FOR SANITATION, PERMIT Post No. 77----- -------- {Comp tW-'% in Duplicate) ''� �- b Date Issued A$plication is hereby made to t e San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in'ii compliance with County Ordinance No. 549. JOB ADDRESS AND LOC ION Owner's Name ........... ------------- ----- .'r��"__�. 3J ! ------------------- ------ Phone------------- --------------------- Address.. --------)--- 4_z------•---�•. •! ----------- '-------------------_ Contractor's Name--------... 1' t,2 -Q-' _`�---------- --- iPhone -------------------- Installation will serve: Residence ❑ Apartment House ❑ Commercial KTrailer Court ❑ Motel ❑ Other Number of living units: ____ Number of bedrooms ________ Number of laths -------- Lot size ________- Water Supply: Public system ❑ Community system ❑ Private ❑' Depth to`Weter Table 7.......f#. Character of soil to a I dept` Yes of 3 feet:4 Sand F1 Gravel ❑ Sandy Loam [] Clay Loam E] Clay Clay Adobe ElPrevious Application Made. No �--k�a'rdp'an i ❑ New Construction:, Yes - TYPE OF INSTALLATION!1: AND SPECsIFICATIONS: g (No septic tank or cesspool permitted if public sewer is available wi+hink feet.) Septic Tank: Distant from nearest well_�j'��stance from fouundatikn'f_s (. t yd K I I __ . --.Mat ria` --- -------C No. ofcompartments_ .__ _ `._.Size__.w. Liquildep#h_�___ Ca acit a.. ` p ,y----t - ---- - Disposal Field: Distance from nearest el astance -0 n a#i n_,____�__ -.._____Distance to nearest lot line__F--__.___-_ PYVA Number o'i dines ._-- -- --------- --- of each Iine______V Width of french- -------- Type of filter material- � .- :pepth of filter material___ i------------- total length------------11_Q__ '. Seepage Pat Distan 0I to nearest welt ___Distance from foundation_____ __________Distance to nearest lot line__.____-______ is a Drstance�fiCp Lining material_-- --- Size: Diameter__ Cesspool m um be of QYe .K. Depth r ' " # rt , ce from foundation ___.Lining material------------------------ 7� +�'• '��,�%� �� P Stz� ,,Dia afar, - -- ----- -- _ H rs l lquirJ"Cap Ty--- t ` i"ar.alh� sa< irk 5} Sy S ! ;,f ;:. y - - gals y• , f Distance from nea st well Y> > (, r , ' eh i : . ante rom ne8rest building: E f Drsta ❑ Distance•to nec�re5f lot line_..._ r `�R3i` S r .,. - r - ,. Remodeling and/or repairing (describe)_________ ___ Y� _ ------ --------- I -------------- ------------------ ---------- - --- - ------------------------------------- ---------� - ;- .`' --••- - •------------•--------•----- ordinances, certifythat I have reared.this application and A -�----�-----L.- State lws and l�rules and r lations of`the San Joaquin the ork wi a adone�In accordance with San Joaquin County Lo I Healt Distri (Signed)--- ... - - - - T �------------ -- � ----- ---- --�� --- -(Owner and/or Contractor) -----------------------I -•--------- - --- `> k (Plot plan, showing size Ti+le --- --------------------- of i , location of sys+em in relation to we building, e can be placed on reverse side). PFOR DEPARTMENT USE ONLY; APPLICATION ACCEPTED BY-------------________.___ . f - - ~ r REVIEWED BY --------- ----------------------- ------ ---- DATE.-- f ------------ "---- -' --• ----------- ------------------------------ ='f . DATE- BUILDING PERMIT ISSUEDA- -•-------------•- ar°ri = = r DATE_ ------------- Alterations and/or recommendations:______..__.___._- I t -- -------------------------- i ly J... ,- _______________------I __________________________________________________________________ 1111 _ ------------------------------------ ------------------------- FINAL INSPECTION f U . .- - -- --;;----------- -------------------- Date---.......--------- ---I--L- - ---------�---- ------�---------•------• SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 Wesf Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M I0-52 Revised W-2100 ... 0.