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i+ ry APPLICATION FOR SANITATION PERMIT Permit No. .to__'f (Complete 1 Duplicate) !_/ Date Issued ___r 74�J__ 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 LOCATION--- _r.-_� _7 /} - --------------- - ---- Owner's Name----- + - - -------E1- - ----- ---------------------------------- - ------------------ ------------------ Phone-ay--- Address--------7/0---- - ----- r ------- ----- :Contractor's Name------ --------- ---- - --- - --- -----------------------2-�` ..-- 5----0- - =----- Phone Installation will serve: Residence k Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -----I Number of bedrooms A---- Number of baths -----/- Lot size --6--n-__k_41-0----------------------- + Water Supply: Public system [ Community system ❑ Private ❑ Depth to Water Table J'-Oft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay [] AdobejA, Hardpan ❑ Previous Application Made: Yes ❑ No 9 New Construction: Yes 5QNo ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public se er is available within 200 feet.) . I J Septic Tank: Distance from nearest well -W�Distancee+from foundation__ -6---_--___.Material__--(t( P -------------- No. _h- -f-__---_. No. of compartments-- ---------------- -- -i �J, -- - -- iquid dept�r------- _ ---------CapacitY-- UfJ - ---- Disposal Field: Distance from nearest wel#�v.-1�--- istanc`e from foundation_ d.�-_-_.Distance to nearest lot line- __ --..-_. Number of lines._ _ / Length of each line Width of trench--- �� - 2---------------------- Type of filter material-- p Depth of filter material._-l5>-f�------Total length_-_-- fXIO-,------------------------ Seepage Pit: Distance to nearest well.---------------------Distance from foundation--------------------Distance to nearest lot line-------.-_-_--_-_ ❑ Number of pits----------------------Lining material________________ ----- size: Diameter--------------- -------Depth--------------------------------- 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------------------------------------- F1 Distance to nearest lot line---- - , Remodelingand/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 r gulatiZ i Sa Joaquin Local Health District. YJ' , (Signed)--------- - ----- --- ------ --- -------------- -----------:!=------- (Owner and/or Contractor) --------------------------- ------------------------- 13y: 'yrs---------------------------------------------------------------(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------ 7 - - - - -------t-�-- -- - -------- REVIEWEDBY----------------------------------------- --- ---- -- --------------------------------------- DATE---- -- --- PERMIT ISSUED____-- -------------- DATE--------------------------------- --:-----: ---- Alteration and/or recom endations<-____-._ --___ - ---------- __ ' �. r - 4 --)--------I--7 - �- -� .�r� * ctr�res. R '` r I f -- ' ------------------------------------------- ---------------------------------------- ---------- -- ---------------------------------------------------------------------------------------- ----- - - FINAL INSPECTION BY:.---------- SA JO CU N LO AL TRICT 130 South American Street 300 W t Oak Street 2S re Street 814 North „C" Street Stockton, California Lodi, a. anteca, California Tracy, California ES-9-2M , Revisea 1.57 F.P,CO. + k