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�tr APPLICATION FOR SANITATION PERMIT Permit No. vd�-A lJ Cyotnplefe in Duplicate) >�/ Date Issued 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. JOB ADDRESS AND LO ATION___9Udo-- - d t - - ----- '�------- -----I------------------ Owner's Name F� - ----rw.Z/ et - n '',,��// ------• --•------ ---------- �------ --------- --------------------- - Phone- -•--------- -------------------- Address------------Q?;K?p i'-l�e ,jl 11, 1-� - -------- -- . _ Contractor's Name-------.__ _ - ------------------------ - Installation will serve: Residence g?"Apartmenf House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: � Number of bedrooms `� i Number of baths _t___ Lot size -_ ___• '1Q� Water Supply: Public system Communify system [] Private [] Depth to Water Table Character of soil to a depth of 3 feet: Sand D Gravel ❑ Sandy Loam ❑ Clay Loam 0 Clay ❑ Adobe [4--lardpan ❑ Previous Application Made: Yes [❑ No Fer New Construction: Yes P'01No Fl-iA/VA: Yes Rq-- �o TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) f Septic Tank: Distance from nearest well____' ?____Distance f om foundation---A--------'..Material No, of compartments____—A-------__.-----Size__-----�-!9-Q___Liquid depth___ -�__ _----------- '�( - - Cap�acitY--•�5�3--•-- Disposal Field: Distance from nearest well.---- ''__ .ir _Distance from founda+ion___f _____.Distance to nearest lot line___'--- --_ Number of lines-----__`__-___. Length of each line__1 �f ------- ------•Width of french-------Z-0 _._______ - Type of filter material /i ._Depth of fil+er material__. � -------- ----Total length_ ----��---------------------------• Seepage Pit: Distance to nearest well------` �------Distance frgm fou ation__ L ----__.Distance to nearest lot line__. --�-_ Number of pits__________________Lining mate ria i_,f - Ay �_ _ . _ ..Size: Diameter�,�,,,�-------------.Depth-----�._0------------------ n ------------ p Cesspool: Distance,from nearest well_________________Distance from foundation----------------___.Lining material__-------------- ❑ Size: Diameter-------- ---.---Depth-------------------------------------- -----------Liquid Capacity Privy: Distance from nearest wellDistance Distance to nearest lot line________ from nearest buildingb - - - ---------- --------------------------------------------- ------------------------------------------ Remodeling andrepairing (describe):_____.__--_� a ------------------------------•----------------------- ------- -a, ------A -------------------------------------------------------------------------------- ------------------------------- ----------•--------------------- n ! hereby certify that ! have prepared this application and (hat 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) - - ---- ---- -------------------------------(0-119P eft4i"or Contractor) BY: -------- -1 -- C � (Title)--- ---- --- (Plot plan, showing size of lot cation of system in relation to wells, buildings, etc., can be placed on revers side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------------------------- ----------- ----------------------------------------------------- DATE -------------------- I;VIEWED BY--------------------------------------------- ------ - ------- t ---------------------------------- DATE ------- BUILDING PERMIT ISSUED ------------------ - - ------------------------------------------------- -- J\ Alterations and/or recommendations:______________ - DATE________ ------------------ --------- -----•-------- ------------------------------•--- - _ _k (0_�a-- -------•--------- ---------- ------------------------ ------------------------ --------------------------------------------------------------- ----------- ----- _. ---------------------------- ------ -- ------------- -------------------------------------------- ----------- FINAL INSPECTION BY:----- ... -------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oafs Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M , Revised 1.57 F.P.Co.