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Permit No. ........'--------------- �� i APPLICATION FOR SANITATION PERM �u (Complete in Du licate p I Date Issued the San Joaquin Local Health District for a permit to construct and install the work herein described. Application is hereby made to 1 2(, --fl o- [ 2— This This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION____-- -- ---- Ph ----- Owner s Name----- - - 1 � - - - -------------•-------------- - �•-•. Address �p D --------- Phone--,,C Z---- Contractor's Name________ ______ __ Other Installation will serve: Residence Ap artment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Lot size -___ . _ -- Number of living units: ---/--- Number of bedrooms .-� Number of baths �___� Water Supply: 'Public''system ❑ Community system ❑ Private Depth to Water Table -794 ft- Adobe Hardpan ❑ Gravel Sandy Loam e0o lay Loam ❑ Clay ❑ Character of soil to a depth of 3 feet: Sand ❑ ❑ previous Application Made: Yes ❑ No New Construction: Yes TYPE OF INSTALLATION AND SPECIFICATIONS: ` (No septic tank or cesspool permitted if public 'ewer is available within 200 feet.) r Material --v" '' Septic ank: Distance from nearest well_-,-ta--- Distance from foundation___._ -_4 Capacity___.-l�-Q_ ''"n Size It x-N - . Liquid depth-`IS r r L ,rNo. of compartments______.---.�. '--------- c�Q_------_.Distance to nearest lot line�------- Disposal Field: Distance from nearest well__fsU-- Distance foundation_____-� of g 'q , ---- 1 --- Length of Iter m!ateria�9-�* ----Total filen length nch. �----------------� - Number of line s_____.-- , - pepth of fi - { Type of filter material.f y.--�` -� -- r ! C/ Q Distance to nearest lot line " De th---g -------- 4. Seep ag Pit: Distance to nearest well---- from fours anon______ ____________ p C Size: Diameter-_-._ __-_._ _. Number of pits--_-__--__l-----------Lining materia.... Distance from nearest well______________ __Distance from foundation.- __---__---_ --.Lining material Cesspool: - Liquid Capacity__ gals- . Si0 . ze: Diameter--------------------------------------Depth_------ ---------------------- ------ ---- --- 9 p Y44. � --- --_---Distance from nearest building---------------------------------- Privy: ------------------------------ - - }Privy: Distance from nearest well--------------------- - ------------ ❑ Distance to nearest lot inE_______--__�-___-_-- ------------------------------------- -------------------- ------------------- ----------------•----------------------------------- Remodeling and/or repairing (describe ___________________ __---•_- -------------------------------- --------------•-------------------------•-------------••--------------•------- I hereby certify that I have prepared �afioa-pplf the San -I that nthe work will Heahe done cin accordance with San Joaquin County t. ordinances, State laws, and rules and regu �} £ c and/or Contractor) (f' ------------------------------------t (Si ned _ ----------------------- 9 -------- -------•- -- intle)- BY:-----------••---• 6- (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 DATE_ ----------------- -----------------APPLICATION ACCEPTED BY -- ------------------------- DATE -7/--- •- � `: -------------- -- - ---------------------------------------------------------- REVIEWED BY ----------------------- DATE BUILDINGPERMIT ISSUED----------------- ---------------------------•---- --------- ------•------ •--------------------------------•--------------------- Alterations and/or recommendations:____-_____._____---_-_ -------------------- - ------------- ---• -------------- - f ------ �^f P � 1")f-------- Date ---- ------------ ------------------------- FINAL INSPECTION BY:-.,-",?__-..--1---------�----------------- ----------- - SAN JOAQUIN LOCAL HEALTH DISTRICT 814 North "C" Street 132 Sycamore Street l3o South American Street 300 West Oak Street 7raey, California Lodi, California Manteca,'California Stockton, California cS-9-21vl 10-52 Revised W-2100