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A\7*1 f iAPPLICATION FOR SANITATION PERMIT permit No. ..... .7._�.7. 1 (Complete in Duplicate) r / � Date Issued .__! 631) -_ rA i 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 AN L CATION------f//..-/�� `�� & �'.j 1 = .1 ZV---------------------------------------------------------------------- ..�/� xl - ..... Phone----- --------------------- -------- Owner's Name.... ---1-x-_41- c^-------"/--Q G f Address--------------- i"7 ------------------------- -----------------------------------_.....-----------------••---------------------------------------------•-----------...- Contractor's Name..... �� S� -.._ :.J'�Cf -' ------ --------------------------------------------- Phone,0 4-y4Q1---- Installation will serve: Residence [l—Apartment House ❑ Commercial- ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ..-L Number of bedrooms _____Z�-Number of baths __/... Lot size _..T;f- _`.__.X.-elk-------------------------- Water Supply. Public system Community system ❑ Private ❑ Depth to Wafter Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe []J_-Hardpan ❑ I - Previous Application Made: Yes ❑ No [g New Construction: Yes ❑ No �! TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank- Distance nearestwell------------------Distance from foundation..------.-.-.--._----Material.....---_.......----.--_ ----------------..------ •f -Size- -= �- Liquid depth----------- - - - Ca acitY -- --------------- E] . rlNoof com artm ents ----- ------------- - Disposal Feld: Distance from neIarest well.-.-_.-------...Distance from foundation--------------------Distance to nearest lot line----------------- of filter material--------- Depth of filter materi f ----------- -------Width n trench------------------------------.__-- ❑f)-(i5 inf Number of lines--- --------- ------------------- _Length of each ine----aI-F--------------------Total length-------------------------------------- Type •-•- Seepage ,Pit: Distance to nearest well-AI&A1,6�-Distance from-foundation---.;-2-4�?-./--.Distance to nearest lot line... p.-�-.- r f ENumber ofp'its_ ...:.,...-.------Lining material _'-CJr_.Size: Diameter--__?J_f*---------Depth--Pbr;---------------------- Cesspool: Distance from nearest well.................Distance from foundation ------------------ material-------.----------_------------- ... ❑ Size: Diameter---- - --------------------- ---------Depth------- �--------- -------------------- -------Liquid Capacity----------------------- --gals. --_-_.....Distance from nearest building Privy: Distance from n n_earr ese t wl{---------- ------ ------ - 9------ ----------------------------------- ❑ Distance to nearest lot line--------------------- ---------------------------------------------------•.----------------------------------------------------------------- Remodeling and/or repairing (describe):-----/ ilf -e� L---- L r -----------------------------•-- ---••-•-----------•---------------------------- ---------- i ------------------------------------------------------------------------ --------- 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 regulations of the San Joaquin Local Health District.- -------- - ner and/or Contractor) (Signed)---------172 `--- ��--- .�.._� ----- ------------------------------------------------------ -_ --------------------- --; ----------(Title)--- - ---------- --- -------- - ------ -------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). i FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------F --------- ---•----------- DATE..---- ------ ----- --------------------------- REVIEWEDBY------ -------------------------- - �-- ---- --- ----------------- ------------------- -------- DATE-------\:`... :.-:.----------------•------------ •---- BUILDING PERMIT ISSUED---------------- ----- DATE sir _ Alterations and/or recommend tions----------------------- -- -- - -- •----------------------------=-- ---- --�� ------------------------ ----- - -- ---- --- - --- - -. ---- --- ------- -- -----------------------------------------------------------------•------------- ---------- 7-•-.. - s ---------------- ------- ------......--•------ FINAL INSPECTION BY:.-- -- ----- - Date- ---------------------------- ------ ----------------------------------------- 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 1 ES-9-ZM 145 Al--54