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wAPPLICATION FOR SANITATION PERMI ,, Permit No. 51 � A r . . (Complete in Duplicate) # 6 Date Issued --- Application is hereby made to the San Joaquin Local Health District for a permit onstruct and install the work herein described. 's application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION Y_j,2--- .------ ------------------------------- Owner's Name__----_--- -- 119 -6.47--------- /-------------------------------- Phone--------------------•--------------- Address hone------------------------------------ Address------------ 2 X- - -57v- - -1 - ----------------- -------- --------X�---- -------;-�, -- ------------ ---------------------------------------- ------ ------------ Contractor's Name----'f' ---------i------ ------- ---------------- Phone-0- ar [:] Installation will serve: Residence 4fment House D Commercial E] Trailer Court Motel E] u Other Number of living 'nits: -1---- Number of bedrooms _ __fA Number of baths J--- Lot size ----115 Water Supply: Public system E] Community system El Private 0--%epth to Water-Table -------- ft. I . — , j Character of soil to a depth of 3 feet:! I ! Sand E] Gravel E] Sandy Loam 0 Clay Loam El Clay E] Adobe E] Hardpan E] Previous Application Made- Yes E] No El New Construction: Yes h---No TYPE OF INSTALLATION AND SPECIFICATIONS- (No septic tank.or cesspool permitted if public sewer is available 'Wif hin 200 feet.) 1 T Septic Tank: Distance from nea,e'!K'e'll"i-0-7-0----Distance from f6`undafl6;---- 0--P------Material--->F r ! -,L� Z2---------------size--- -----Liquid depth--N-'f*--------- No. of compprtment'- _1Z -----Capacity----- Disposal Field: Distance from nearest w�ellj��---.Distance from foundaltion---/ ' _/1-0-------Distance to nearest lot line--_.,!� 111-� Number of lines-------------- Length of each line (00 ................Width of trench---,,�-7---------- Type of filter material,di Depth of filter material------/--- ?___-__Total length----A-()------------------------------)%, I Seepage Pit: Distance to nepreft we}J--/-- ----------Distance from ound6f ion---- _______________Depth_____- 17ce to nearest lot,line-0?----------- Number of pits,-_-___ Lining material--,, WA§ize: Diameter- --------------Dept h I- �Y- A. �*__ :: ` Distance from nearest well-----------------Distance from foundation-------------1------.1-ining material_-___________-___________.__________. - ------------------ - --- -------- El Size: Diameter-------------------------- - ----- -------------- - -- --- -------------------gals. Priv Yr Distance from nearest-well----------------------------------------- _ ____Distance from nearest building------------------------------------------- ElDistance to hearpsf�lot line____________ - __A ------- --------rte,;:--------- ------ E. Remodeling and/or repairing (descri be):-------------- eA --- --- -----------------------------------------------•-------- I----------------- --------I--------------------- -----------------------------------i-------------------------------------------------------------------- ----------------------•-------------------------------•-------- ----I---------------------------------:-------------------------------------------------------------------- I t P ----------------------------------------------I-------------------- ------------------------------------------- ' I-----------*----------------- ------------------------------------------------------------------------ k ------�;Z� 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' 'regulationsof f -*SS p oaq J juin"LocalI-pe lfh'Disfric+. 4 _I )_ (Signed)----------------- --- -------- V ------- ----- ------ ---- ------ �e4 �---- (Own er..,.a:,,nd/or,;�Contracfor) ------------ B ... --- ------------- -------------------------- -------- -----------(Tif le)----7------�--4�- -d�z ------------- (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 j APPLICATION ACCEPTED BY------------ -------- --- ------------------------------------ -DATE- . ---�;.;---------------------- REVIEWED DATE-REVIEWED BY------------- DATE--' --------- :---------------- . ...... ------ BUILDING PERMIT ISSUED_-------------- -------- - DIATIE'-------------- Alterations and/or recommendations:-_1--------------------- - A ------------------------------------------7-------------------------- ------------------------------------------ ---------------------------------------------------------------------------------------- -----------------------7------------------------------ I-------------------------------------------------------- ----------------------------------------------z------------------------------------- ---------- ----------------------------------------------- --------------------------------------------------------- ----------------------- --------- :,,! - . ----------- :-----------------*--------*-------- --------------------------------------------------------------------- ------�A:l------------------------------- - --------------------------------------- -----------------------------------------------t.... -------------------- -- , ---------------------------------- ------------------�7 ------ ------------------------------------------------------------------------- FINAL INSPECTION 'BY---------- ----_--- ------------------------ �: `� ✓ �.� SAN BY:--------- SAN JOAQUIN LOCAL HEALTH,DISTRICT 130 South American Sfraef 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California. Lodi, California Manteca,' California Tracy, California E5-9-2M B-51 Revised W-2100