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"1 APPLICATION FOR, SANITATION PERMIT i. Permit No. /�'] r� (Complefe in Duplicate) !l/V .. _ , _ ,_._ Date Issued XED Application is here6y•-made to�the SanJoaquin'Local~Health"District for a permit to corisfruct and instal he ork,herein'descrilaed. This application is�made in compliance:wifh County Ordinance No, 549. a . ,' _ !`- i JOB ADDRESS AND LOCATION. -��----_ ---c d%--7 iL;�_ :: f=>� r t Owner's Name r$� _------------- ----------------------------h ae .. n C Addr ti P # ass -------- -•--------^ .. .i�id'.... _.._ 1 � .• Contractors Name----=-----------•-----•- ��'•-�--�----•----- � ` Phone AVO:— 1 Installation will serve: i ResidenceER"-Apartment House Commercial r 5. ❑ ❑ Trailer 'Court ❑ ' Motel- Other ❑,. t.Y I Number of living units mber of bedrooms -Number of baths 'ILot-siza '.. �. -- Wafer a - Wafer Supply;` Public system" . Community system❑ `Private.❑ bepth-to Wa}er Table 9„5ft.''-' .'"*'., � 5a Character of'soil to a depth of 3 feet:- Sand ❑ G'ravR I❑ Sandy Loa ❑ .iClay_L.oam E]Clay [] ' Adobe Hardpan ❑ Previous Application Made:- Yes ❑ No,Eg-.-Tlew Construction: Yes No -µs TYPE OF INSTALLATION AND SPECIFICATIONS:„ t (No septic tank or cesspool permitted if public se' wer is'available wifhin 200 feet.)44::_ _ j ► i Septic Tank: {Distance from nearest welf--------- -------- Distance - from foundation ---------------------Material Jam' 1 of compartments ----------------- Size = Liquid depth - -- ----Capacity Disposal Field:. Di ance-from nearest well...." _----- . Distance from foundation ------------- ____.D�sfance to nearest:lot line -------- ------- a ❑ of. lines_ ------- ------- ---------- ------ Length of each line------ •_ - -:-- ` -- Width of trench -- Type- t TYPe.bf filter material---.._ .--..._- --=- �------- # Depth of filter material � _# -__- ------ Total length -------------- y See .a a Pim Distance 'to nearest well.. -Distance -from foundation.... _ Distance to nlip earest lot ime"_'7,,_9.�.. Number of its- : i._..:.' --Lining materiaL.;Y. c?-� -k'--'Sizei Diameter ._ _J-11 ------- Depth __._�,------------- Cesspool: l _- _--- -- Cess ool: Distance from i P neares#'well _- -_ Distance from foundation .. .Linin material -...._ Lin -Ing = --- ❑' " Size: Diameter:.. _.Depth :-Liquid Ca p acit Privy: Distance from nearest well " ...^" ' _ . Distance from nearest building ❑ Distance to nearest lot lire ','-::`----� ... .' Remodelin and/or ��65•� _ _ � 1 - •" - g / or re airin�--- ---- -�-'- -p rsi �.� ---- -- ._______....._ . _i - - ... .... . ......."-.__._..- ------------------------------------ _ _ _ f - I hereby certify that I have -prepared this' application" and ' that the work will be done in accordance wifh San Joaquin' County ordinances, State laws rrd rul and r s' of f e San Joaquin Local Health District. ......... '- �' S e // f x - - - ------ -- (, g er and/or Contractor) BY _ /�fes/�[Own �' (Plot Ian, showin s . " p g s' of lot, loc tiara of sysfem in re afion fo wells, bui mgs; a#c„ can be placed on reverse side). DEPARTMENT=USE'ONLY. APPLICATION 'ACCEPTED BY_- --------- _-._.DA�149�74 s - ----=---------- REVIEWED BY ----------------------------- ', DAT:=---------------------------------- sF, BUILDING PERMIT�ISSUED---- -;_ p ' L --------------- - ---- AItions and or ecommendations - n' ------ - . ---------- - - - -- ----- V T --- -------- -- ----------- ----------- -------------------•---- -- - .._-• -- - 1 4 -_.. .. ....r ...._-__ ---------,"------------------- i ---- - ------• ..:— ---------------- a---------- - ----- -------- ----------` ',T � FINAL INSPECTION BY: _� , �j;(�jj-�--Date.: �-. .�V SAN JOAQUIN LOCAL HEALTH DISTRICT I 130 South American Street 300 West Oak Street 132 Sycamore Sfreef 814 North "C" St:eet Stockton, California Lodi, California Manteca, California Tracy, California ES -9-2M Reviser! 1.57 F.P.CO.