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r-- �- V a,VX�` APPLICATION FOR SANITATION PERMIT Permit No. _71v,-`5-_-�- (Complete in Duplicate) Date Issued ___ ?,/sZ-- Applica}ion 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....6- 7--6-------M-8-�1_�.�_f' =_ A. ------•-•--•------------------•-•--------------------------------•--------- Owner's Name.-•_,q--1 _,.S--------- �-V 1 --------------------------------------- ----------------------------------------- - Phoney 3 . Address------------- I'Yl ----------------.-:..----------------------------------------------------------------------------•--------------------------------- Contractor's Name--------- l Q17i H 'llG-----------------------------------:------------1-1------------------ -------- Phone.*,.--�-- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __1-_ Number of bedrooms _JNumber of baths .J._ Lot size ---4U_-S-`---x 7---____-_____ Water Supply: Public system ®r—c-ommunity system E] Private F] Depth to Water Table _.fo'ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay-❑ Adobe U]-�ardpan ❑ Previous Application Made: Yes ❑ No [0— New Construction: Yes E� No ❑ , TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) j ` CfL If/-/•C 4. Septic T k: Distance from nearest we1lIVO/�EDistance from foundation----_e_____...Materia`--_____________________________________________- ge No. of compartments----- %. -------Size_L 04F -f- .-------Li-Liquid de #h------63 J. q p. Capacity Disposal Field: Distance from nearest well-/Vd�Distance from foundation.---_A16__ ----Distance .to nearest lot Ii e�_S$________- Number of lines--------I_ - W. ---------__Length of each line__ _6._r-F_. ._.Width of trench------ '_� _________________ Type of filter material._1__y-__-S -----Depth of filter,material_-__-/ .. __Total length-------._3S__�...._ See pag it: Distance to nearest well-/4d��---Distance rom ."_Distancefoundation_-.-_ to nearest lot line___$7______.- r Number of pits-____...1-----------Lining material_,�C�P-*'__.Size: Diamete r___.._-..._.-_--Depth_-_-��________________ Cesspool: Distance from nearest well________________Distance from foundation--------------------Lining material__-.____--..-_------._-__________-_-_. ❑ Size: Diameter--------------------------------------Depth--------�-------------------------------------------Liqui.d Capacity----------------------------gals. Privy: Distance from nearest well............._--.-.___--------_____.-..---------Distance from nearest building__________._.--_--_____________----_____. ❑ Distance to nearest lot line------------• '............. ---------------------•------------ ---•-------------•-- ------------------------------------------------ Remodeling and/or repairing (describel:-------IVI?!co---_ �_ e_i __._ _____ uT-U,eL' --- S f_ i ----•----------------------••-•---------------------------------------------•-•---------------------•-------------------------------------•--------•--•-_--------------------------------------- -----•------- ---------------------------------------------•--------------•----------------------------------------------------------------------•----------- •---------- •--------------------------------------..._.--------- - I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, St laws, and rules and regulations of the San Joaquin Local Health District. (Signed)____ ---- _1 /r'� ,.,r/� r---- - ------------------------------------------------------------------------ _ wrier and/or Contractor) By:.... - ------------- -- - (rile)-'• i (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed an reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY DATE- --• -------------------------------------------- REVIEWEDBY---------------------------- --------- DATE--- --------•-•--------------------------------- BLIILDINGPERMIT ISSUED----------.. -;;--- --------•---------- ------------•-----------------------`•------------------------- DATE-------qA------------------------------------------ Alterations and/or recommendations:----------- -------------- ----------------------- -=-------------------------------------- ----•----------------------------------------...-------- ------------ ----------•--- - ----------C:- ----------- ---------- - •-- --------- - -- ----------•----- ...--•------------------------------------ ----------------------------- -- -- --------------------------------•--------- -----------------------------•-- --------------------------- ------------------------------------------------------ - --------------------- ---=-- ------- ---------- i ------ --------- ------- - -------- ------------------------------ ---�__S�.FINAL INSPECTION BY:.. ----- Date------- r ` SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California E5---9-2M 145446 ATWOOP 12-54