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APPLICATION FOR SANITATION PERMIT Permit No. _72-1-1-2-------- (Complete in Duplicate) ` (, r�- - ^-W..--�.. Date Issued � -�' "� 3 -lue t C=fz;F_- Cv-00 v C_ Ze 0_5,g--t Ga—02 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. r JOB ADDRESS AND LOCA ION.. -' c+ =-'-- ----- w?Qsr ---- f'r✓!s i k"'_p1 G' d 0C. ,w� f ��-�� Owner's Name..� f? -/------ ------' jc- a_t*t? Phone Address-.------ J------ c'.. �� '� �y r�' j D J'` ' �`��` ................ f� ,rte Contractor's Name----� -e X5-'`-4 - r J `------------------------------- ------------ Phone------ Installation will serve: Residence Apartment House Commercial ❑ p ❑ ❑ Trailer Court ❑ Motel ❑ Number of living units: -------- Number of bedrooms -------- Number of baths -------- Lot size ----- Water -__Water Supply: Public system ❑ Community system ❑ Private ©--6e`pth to Water Table,__3.-:�_ ft. f- Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: Yes ❑ _Mo [1--N _: tom; s� �-� �•� -_ •� TYPE OF INSTALLATION AND SPECIFICATIONS: i Se tic Nokse septic tank Distance nearest ell�clic sewer � ( p p p R p ailable within 200 feet.) , E' f , y� p from foundation./. / �® Material-- -----C-' Vis?--- - -�-K_-------•. No, of compartments....-__.:' -___.....__Size__. `r. f. Liquid depth d ------._Capacity_/$'_'`0------ y� Disposal ield: Distance from nearest well--- from foundation---594-z--- .Distance to nearest lot line.....eF!____ Vv • Number;of lines------------A_1 Length of each line-------- --�--7-'.Width of trench------�''-_�-�� ---_-- /r 7/ f l Type or filter material-----t l----53 aha-Depth of filter material---..1. __...._---.Total length------_ s� Seepag rt: Distance to nearest well< .(S _____Distance from foundation --/! er.`_Distance to nearest I t line [ Number of its----!- -- __.--- - - Linin material_ �!C- p + p p g `; . De tn__1_ `. Cesspool: Distance from nearest well-----------------Distance from foundation....................Lining material------------ _------------------------ El - -----._------.__---_❑ Size: Diameter--------------------------- ----------Depth--------------------------------- - ----------------Liquid Capacity--------------------- ------gals. Privy: Distance from nearest well---_-------------------------------------------.-Distance from nearest building-------------.-_----______._.._______._. ❑ Distance to nearest lot line------------------------- Remodeling and/or repairing {describe}:_._.: +.f- -------- Orr— -------- �1��'-` -�dfy-•---- � --------------------------------------------- ---------------------•----••----•-----------------------•-- --------------•-----•------•------------------•--------------------------------------------------------------•------------------------------------------------------------•--------•----------------------------------------- 1 hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, to laws, and rules and regulations of the San Joaquin Local Health District. (Signed)-- - lvxxl-yl -- ..............-- ----' ...... =----=:"_ .--_- O nor•and/or,Contractor)--� BY:..... ' -�"~-r„--------------------------------------------{Title) ; -----•-------- - ---------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY- - ----------- ------- ---- -- ------------------- ---------------------------------------- DATE. ---------------- REVIEWED •--------- REVIEWEDBY----------------------------- .--- ------------------------------------------- - -- ---------------------------- DATE---�_X-----------------------••----------------- BUILDING PERMIT ISSUED------------------------------ --------------------------------------------------------------------- DATE-- ~: Alterations and/or recommendations: - ----------- - --------=------------------- -•-------------------------•-------------------- •---•--------------- FINAL INSPECTION BY:-- - - ---- ---------- DaVICT - - -- -�-�---��------------------------------- SAN JOAQUIN LOCAL HEALTH DIS 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C” Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M 145446 ATWOO❑ 12-54