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-,�s----- ------ -- -_ APPLICATION FOR SANITATION P .�! -------- l=RMIT Per No. ...:�-�– (Complete in Duplicate) A --------------- .--.3.7 This Permit Ex fres 1 Year From Date'Issued �116pplication is hereby made to the San Joaquin Local Date Issued -____-- 0 This application is made in compliance with uin L Health District for a permit to construct and install the work herein described, � County Ordinance No. 549. JOB ADDRESS AND LOCATION_.- � ��Q f"r? Owner's Name � �•------•-------- __.-�_'y_•_�Qv -•--•-•--- Address_:----• ------•-------- = --------- --•- - - --- --------------------- -------- --------- � Phone...- - ---- „ • Contractor's Name ,--•�� t "---------------------- - serve: Residence Phone_ Installation will ! • - Q ❑ Apartment House ❑ Co martial � Number of living units: _- Number of bedrooms __- Number of ahs rail Court Motes❑ Other Water Supply; public system Community system Lot size --yO' -- 'f'----------------- IZ-.C9 Character of soil to a depth of 3 feet: $and ❑ Private ❑ Depth to Water Table --_---- ft- E [] Gravel ❑ Sandy Loam ❑ Clay Loam ' Previous Application Made: (If yes,date---_-------- - !-1 No ❑ Clay❑ Adobe y TYPE OF INSTALLATION AND SPECIFICATIONS ❑ .New Construction: Yes Hardpan [] [No septic tank or cesspool permitted if public sewer is � No ❑ FHA/VA, Yes ❑ No 5eptic�T Distance from nearest wefl_N-n-y- -- available within 2D0 feet.) U Distance from-foundation_--l-Q' / No. of compartmenfis_._--- .---- Size__-/_` _/ t� ----•---Material---2��oQA---------------�- ----� Disposal Field: Liquid depth__.__ _ p" Capacity Distance from nearest wellA d6__ -Distance from foundation___ Number of lines_ ----_ _ _ g ©--:._._.Distance to nearest lot Length of each line__-____4551_,0--Type of filter material• � ----Width of trench_._.. - Seepage Pit: .0 --•Depth of filter material--_- •� __ ---------_ Distance to nearest well-t, _ -------Total length-- T.' Distance from foundation--- ---Q� •------------------- s Number of its---_----- -- .1^�y- Distance to nearest lot line_-----,5"1 ' •---------Lining matenal_1�o-�- Cesspool: ,Distance from nearest well-------- r. size: DiamEter_ _,3..r Depth Distance from foundation--------------•---- Lining material__.__--------- ---------- El Size: Diameter-------------------------------------- �.. PrivDepth----------------------------------------- - y' Distance from nearest well--------------- " Liquid Capacity------------ ------------ ❑ Distance to nearest lot line_____--,-------- --------------Distance from nearest building, gals. Remodeling and/or repairing (describe):__-___ -- - 3 . - .... _ ----------•---------------- •__ -2° c` ---------•----------------------------- ----- - e -tif - - - - e --are his a ca ------•------------------- ---------------- --•-----------•-----•--------- --------- I`hereby certify that I have prepared this applica+ion and that the work will be-done in accordance with San Joa uin Cou ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. q my (Signed)------ {, er = nk - y c�, = , --------------- --------------------------------------------- - ° n rector) - ------ - - [Title)--.--------- (Plot plan, showing size of lot, location of system in re n to wells, building etc,, can be placed on reverse sid e), —� FOR DEP NT USE ONLY APPLICATION ACCEPTEb REVIEWED BY----------------------- ------- ---------•--------•-- DATE----------�-�--p--"--�--Q........................ BUILDING PERMIT ISSUED------- ---------------------- ATE _ -----,---- --- ------------- -------------- D - -----•.-------••-----•---------------- ------- -- --- -----t-e--r--a-ti-o--n--s---a--n-- d/or recommendations:--.- �. h t2 ` -` ` -------- _.-------------- --- --- ------- ---------- -• -- ••-•- ---------- ----- ._ --------------- 77 ------------- /� . . - ------------ INAL INSPECTION ------ Date-- ---- j. SAN JOAQUIN LOCAL HEALTH DISTRICT 730 South American Street 300 West Oak street Stockton,California 124 SYcamore street Lodi,California SOS Went 9th street EB-4 R¢v+6eo e•59 F,p,pq.ZM 5.60 Manteca,California Tracy,California