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✓_ti � [ Permit No. 7 - APPLICATION FO SANITATION PERMIT (Complete in Duplicate) p,--. •Issued ___7 � �_4 Application is hereby made to the San Joaquin Local) Hdealt�cplNoc for a-permit to construct and Inst: ..'e woZ ,16� escribo This application is made in compliance with County ------------- - - ----- ------------ - ----- JOB ADDRESS AND LOCATION--------- ------ x'l_ _ ----- •-------------- Phone_ �1�--�?' ------ -- -- -- ------- - Owner s Name `-- i ----•---- ------------------------------ Address �--;;� one-------- ---------------•---------- - "---------------------------------------------------------- Ph Contractor's Name-- _____-:_._ --- Other " � Commercial ❑ Trailer Court ❑ Motel ❑ �� Installation will serve: Residence �C] 1 Apartment House ❑ i Number of living-units: --- Number of bedrooms -3--__ Number of'baths --- Lot sizeft. Water Supply: Public system Community system C] Private ❑ Depth to Water Tablet/ft. PP y' y Cla Loam Clay Adobe Hardpan ❑ Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ y. ❑ y ❑ N fo v J1,6— .6, 1?• 1 r® No ❑ New Construction Previous Application Made: Yes : Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (Na septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well--- _-----Distance�from�foundation___, __-------.Materiae--- 'a acit� -a�-- No. of compartments------------------------Size.l� __ _ Liquid dap#h * Z p Y Disposal Field: a + Distance from nearest well_---_"~--__-Distance from ;ne atiar ----------Distance tftfrench re c est I line-_-_--_._-__- p 1 ® Number of lines------------- �------ --- -------Length o each io �-------------•------�--. Type of filter material._--_��_�------Depth of filter -- ------Total length_-__---_=-�____. See a e Pit: Distance to nearest well_ --------------Distance from foundation--ia------ ---Distance tonearestlot line.___- ------- p g Lining material----------------- ❑ •1 Sl-,_cumber of pits------------- Distance from nearest well -----------Distance from foundation--------------------Lining material---_-------___-_- _-- --- Cesspool: _- Liquid Capacity- 9-a-Is. ❑ Size: Diameter------ -------- - ; Depth _ _ .rt , s�. „e.- ,, " „ :- 7------------------- Distance from nearest building---------- --- -------------- : _: pistance from nea e-_sf ell__-❑ Distance to nearest of me- "-_____-_____________""_ 5 pl�..c= A-r�l�.. 1- -----�.e --- -------- ------• -° _7 R�- ---- f- Remodeling and/or repairing (descrrbe :____-._-- - �/ _,c- -_-__ ------------ f 't '' ..._ ---------------------------- r I hereby certify that i have prepared eparegulationsdthis Ili ttio San Joaa the LoworkHeall be don ct n accordance with San Joaquin County {r ordinances, State laws, and rules a t- ---------------------------(Owner and/or Contractor) tSi ned q ) (Title)------------------ --------------------------- By:•---------------_---------- --- (Plot plan, showing size of to , location of system in relation to wells, buildings; etc., can be placed on reverse side). FOR DEPARTMENT USE NLY _ r. --------—DATE--------- --- `�� ----------- APPLICATION ACCEPTED BY------ • � ---- ------- __ DATE----------------------------------------------------------- ------------------------------------------------•--------- REVIEWED BY- --- ----------------------- TE ---------------------------------------------------- PERMIT ISSUED---------------------------------------------------------- ------------------ -----------------------•-------------------------------- - Alterations and/or recommen ations:-_-"----------------- ----------------------------- ---------------------------- - --------------------- --- ----------------------- ----------------- INSPECTION BY: - ------ --- - -------------------- Date FINAL SAN JOAQUIN LOCAL HEALTH DISTRICT 132 Sycamore Street 814 North "C" Street i 130 South American Street 300 West Oak Street Tracy, California Stockton, California Lodi, California Manteca, California ES-9-2M 8.51 Revised W-2100