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APPLICATION FOR SANITATION EPEWIT "' Permit N 15— II (Complete in Duplicate), ° l.' i - - Date Issue TF �C .5 A'pplicafion is hereby made to the San;Joaquin Local Health District for per to Tlis application is made in compliance with County Ordiri 1i ? ante No. 549, p - construct and install the work herein described. JOB ADDRESS AND LOC ""` _T p Owner's Name _._. _ ------ (j ,S'zL . - - e / --------------------------------------- ----------------- Address EI dela 'ag� ' Cl _Qf -_._. ,�. k C' l- '--------- -- --------- -•----4Q-.S._�---•11�t�f. _ -- ------ Phone---�------ it - ---•------------------------•-- r o�tractor's Name-_. ----------------- ---R6Y_d_.-_ a_Q. Installation will serve: rResidence -------- ------ Ph ❑ Apartment House onef5fs••__y_p� � (, Number of living units - ___ ❑ Corr►mercia� � T�ile Court SeNv.� ❑ Motel [� Other Water'Su 1 l Number of bedrooms _-----_- Number c aths _-__- �� PP Y• Public;system El Communit /! r Y System – •-•--- ❑ Private - ------------------ Character of soil to a depth of 3 feet: �Sand Depth to Water Table .y�{t. _ Previous Application Made: Yes f : ❑ Gravel ❑ Sandy Loam [] Clay Loam ❑ Clay ❑ Adobe[ erdpan ❑ TYPE OF INSTALLATION AND SPECIFIC�ONS;Construction; Yes �o ❑ {No septic tank or cesspool permitted if public sewer is available within 200 feet. I Sept Tank; p . Distance from nearest well_• -- - No. of co 11 artments--_-_-. Distance from foundation-_-- 4 p �----- -----Size_-'�CX-S6 Material---��" 1__ y � p -3 Dis iosal Field; :- Liquid depth_--_-_y 0--- _ -� --------- ' a acity-,_1lsan om nearest well 4_6 _'Distance from foundation-_-2_d` Distance to nearest lot line_-- � Number of ' _ rs ante rlhnes----------/-_ --_ Length of each line_----- SO' + ?1 -•e filter material-s ------------- --- Width---- Type of filter material-_---18 '• See a e .it: :: t / --------Total length-------•Sa' --------- ------ ' .i- t:nearest,well_ Q ------- :,Distance from foundation-.¢_Q_� S ------- �'� Distance ta' Number of;pits---_-/ ------------Lining material-----Ro,Cfe' . ---••--.Distance tonearestlo�lse--__ Cesspool: .Size: Diameter__-- u __'' Distance from nea est well-----------------Distance from foundation.-__________ I e h+ - Z Size: Diameter--- _-__ -------.Lining material_------------------------------------- -------------- ------------------------Depth------ Privy: Distance from nearest well------------------ --- ----Liquid Capacity-__-__-__--__- s . # ---- Distance toearest�lot line__'__-- ` -Distance from nearest building g -------------------------------------- ----- emodeling and/or repairing (describe):------___- , "- ----- 1 ,r - -- _ - , •--- --------------------------•------------------------•---------- .> - ---------------- --- -------------------------------------------------------------- ------ r ----------------------------------------------------------- ! hereby certify that I have{prepared this application and that the work will b- done in accordan ordinances, State laws, and rules'`and regulations : the San Joaquin Local Health Distric}, rice with San Joaquin County (Signed)----- i l _ ✓�C eon C fad �o {� BY:--•---------- •----= ) ' -------- (Owner arid/or Contractor) -- , -- --:----- I t -------=------------------------------ --- {Plot plan, showing size of lot, tote+ion of sysin relation to w~ells, buildings; etc., can bele laced an r �an -- ,l (Title) S$� S P averse side). --------- - --- p. FOR_DEPARTMENT USE ONLY �I APPLICATION ACCEPTED BY------- / REVIEWIED BY------- ;i --------------------- -•----------- ---------------------------- DATE T�" BUILDING PERMIT 'i----------- ................ ------------------------ DATE ------ -- --------- - -------•----------------- --------------- --------- Alterations and/or recommendations:-___-----_______________ DATE-__--____-- IM M --------------------- - ----------------------------------------_--- ---- --------._..- ---------------- - ----------- --------------}------------------------------- /M"6 FINAL fNSPECTION BY:.--_-_----_µ G� "-------------------------- y Date-_._:----- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street qa§ 30D West Oek Street 132 Sycamore Street Stockton, California �' 814 North "C" Street I Lodi, California Manteca, California I it Tracy. California ES-9-2M Revised W-2100 11 '