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�1' } APPLICATION .FOR SANITATION PERMIT Permit No. _ s 11_- _.. (Complete in Duplicate) Date Issued . !. . J e . Application is hereby made to the San Joaqu ri' Local Healthe wor h '�Districf for a permit to construct�arid�install tharem described. This application is.made in compliance. with County Ordinance No. 549. -. JOB ADDRESS AND LOQATION - -1-- �--- 1. r �,s_ J• j s Owner's Name------- t. -1 -�--�Y .- -------------------= --- ----- -- ------- -- Phone Address / c7� � _ ;� _ CSX!4 _ _-- '� -------------------Y - - ---------------- Contractor's Name-----L• /�___'------ ---- --------------- ' Phone Installation will serve: Residence [Apartment House ❑ Commercial ❑ Trailer Court ❑ nMof I ❑ Other ❑ Number of living units: __1____ Number of bedrooms _�-_ Number of baths _�-___ Lot size _�_!�- _�,X_-COO. 671 •-------- ---•---------- Water Supply: Public system ❑ Community system ❑ Private [r Depth to Water Table Character of soil to A pth of 3'feet: ~S��GNew Gravel ❑ ndy Loam ❑ Clay Loam [:] Clay ❑ Adobe ardpan E]t Previous Application Made: Yes E] No Construction: Yes ®�No ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: - ' (No septic tank or'cesspool permitfed if public sewer is available within 200 feet.] 1 - 1 { Septic ank: Distance from nearest well��tance from foundation_��---- --�---- Material--- d No. of compartments----------- - Size--------------- ----------------Liquid deRth----------------- ---------Capacity-- ----- ' Dispos € Field: Distance from nearest wellQD'istance from foundation!0Distance to nearest lot line_t_�?. �, [y Number of;lines_____ ___________ ___Length of each line------ �r� Width of trench-------tof __ -- ----„_. Type'of filter materia'I—" Wtr-Dept} of filter material___ _ __ ______Total length_.__________ ________ _________s � " '4 `I` � _bistance om foundation--..___ _.___.Distance to nearest line____-s._p ge Pit: Distance to nearest well' 1_____ ------- Se Number of pits.-- ----- -{------Lin.ing material__r#�_��fiZe: Diameter-------- -r -----.Depth--- .- ---------'- �M _ r � . Cesspool: Distance from nearest well------------------Distance from foundation--------------------Lining material----------------- El Size: Diameter-------------------`-------- --_...Depth----------------------------------------------------Liquid Capacity- ---------------- gals. Privy: - Distance from nearest well-----_-----------------.--------------------------Distance from nearest building_____._____________-_______-_----_____--- [] Distance to nearest lot line_.______________... -- ------------------------ Remodelingand/or repai.I g (de)Qribe)-------- ---------------------------:--------------------------------------------------------__--------------------------------------------------- -------------------------------------------------------------------------------------------------------- _1Z --------------- r _.`�.�.--:A)lAl ------------ ----------------------- -00-------------------------------------------------.-.------------------._.-- ------.-I-hereb certify That I have prepared this-a application and that the ryo�wil�-----------------------------------------•--- ---------------------- - - _ �-4' � Y y p p pp done in accordance with-San Joaquin County K ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. `r. �t -------------------------------------------(Owner and/or Contractor) (Signed)-----------�2--�--1------- - _ ----------------------- ------------------------------------------------------------(Title)-------------------------------------- ----------------------- (Plot plan, showing size of lot, location of system in.relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED 13Y _ ------ DATE_-------------------------------------- REVIEWEDBY------------------------------ ~------------° = -------------- DATE--- BUILDING PERMIT ISSUED-------------------------------------------------------------—-------------- -- -------------------- DATE----- ,�-`------------------------------------------ Alterations and/or recommendations------------------------------------------------ --------:--•--------------------------••-------------•-- •-----------------•-------------------------- o , --------------=•----------•---------------------- ------------ ----------------------------------- ----OL--- --------------------------------- ----OL--- --------- - ----- ---- -— --_.. -------------- _ . = ----- - ------- - ` - wt --- . FINAL INSPECTION BY------------------ - - LW-------------------=- _ _ Date `-=-- t'7 = ------------------•------------- ►S N JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C” Street Stock+on, California Lodi, California Manteca, California Tracy, California ES-9-2M . Revised 1.57 F.P,Co.