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1 1 APPLICATION FOR SAN Permit No. ___." ____..�.. SANITATION PERMIT ^ ' (Complete in Duplicate) r� Date Issued ,F = Application is hereby made to the San Joaquin Lodal Health-District'for a permit to construct and install the work herein described. This application is made in compliance wiWCounty Ordinance No. 549. JOB ADDRESS AND LOCATION------ — s - f dI-- ---------------- Owner's ' -----Ge't3v' 4z� ------------------------- -- )" ..M Add ress----------------------------- ` PhoneContractor's Nam ----=�-�-l�y-"------ -------- -=--------------------- -•---------------------------------------- % Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ r Number of baths ._ { Lot size --_ ._. _ Number of living units: __ 4 Number of bedrooms _,� ��--�;�+��------------------------- Water Supply: Public systemCommunity system "❑ Private ❑ Depth to W Eter Table, Water Character of soi to a?depth of.3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ -Clay Loam ❑ Clay ❑ AdobeXl Hardpan❑ f � l Previous Application Made: ❑ No New Construction: Yes ❑ Noy FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: , (No septic tank or cesspool permitted if public sewer is available within 200 feet.) S eptic'Tank: 4e Distance from nearest wek_15__.J-__6istance from foundation__. A """""""".Material" __ _ZCh..r� y No. of com artments-____ Size._ s �Li uid de th______._ Ca acit p _ } q p. p y_, -- -6r- .-. -- -_ ' ° ' Disposal Field:' Distance from nearest well_�O_-_Distance from•foundation"-a-_C)__"__--Distance to nearest lot line_____.____. Number of lines___'______ -----_a___-__.Length of each line_�z _=;��`_- _ dlVidth of trench___ , -��------"---___---- + -. Type of filter materiaLC �-�.�--______Depth of filter material-__��_f__.__.____._Total length:___�,�`__�________________________ W F . Seepage pPit: Distance to nearest well-----_-- --______Distance from foun$ation---------- .........Distance to nearest lot line------_.---._.___ C1 Number of pits----------------------Lining material--------------------..Size: Diameter-----------------------.Depth--------------------------------- r CCesspool: Distance from nearest welL__--------------Distance from foundation__-------------.__..Lining material------------------------------------- . ❑ Size: Diameter--=----------------------------------Depth--------------------------------- ------Liquid Capacity----------------------------gals. _ -- -- -- istancf� - orn nearest building-------------------- ------------------- Privy: Distance irom E] to ea esneat lot line st l ---=----_-- --- ------------------ - - ---------- -------------------------------------------------------------- 1,4 ---------------- 1 - Remodeling and/or repairing (describe):---------:--------- -----------__----------------'------•----:------------------------------------------------------------ ' i . .-y f ------------------- --= ----------------•-----=------------------------------------------------- _ r # ------ -------------------------------------------------- - = ---------------------------------------------------------------- I hereby certify that I have prepared-t his'application arid'that the work will be done in accordance with San Joaquin County ordinances, State and MR— regulations of the San Joaquin Local Health District. w } (Sig ed)_ J fes° --------- -----F - - - {0ner and/or Contractor) AA AaBy:------,.r 4;__1 ...........-�-••---••-----•--••----------- ----------:-----------------•--------------------------- -----(Title)---------------------------------------------------------------- (Plot plan. ------ ---------------- (Plotplan, showing size of lot, locatiowof:system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED SYk :: - _ ;fix - DATE. r aj ---------------------- BY----- ------------------- ---=- ---------- REVIEWEDa-- " Il DATE - !� 1 �--- I BUILDING PERMIT ISSUED------ / ! = T------ --------------i ----------------------- DATE-----�__y._... th.- - �- ---- - - !- �c-o nda ns:- q�- - `f } '1a.1 3s.4J�. - ---_-_�---- Alterations and/or recomme w _ ---fid -. -------#- ------------------ ----------------------------------- --------------•------------------ ------------- -------------------------------•--------------------- ------•------------ e _ _______--_"_-- __. # € ------------ r FINAL INSPECTION BY:. f - y- _ Date f` 5 7 1 ( SAN AQUIN LOCAL HEALTH DISTRICT 130 South American 132 Sycamore Street 814 North "C" Street Street + 306 West Oak Street Y Stockton, California + Lodi, California Manteca, California Tracy, California ES-9-2M Revised }.57 F.P.CO.