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_ APPLICATION FOR SANITATION PERMIT Permit -No. .__ f..S--70 n_�, (Complete in Duplicate) ra 3 (-5q Date Issued Application 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 AND LOCATION----Y/5"---So --------------------------------- -- Owner's Name-----`�--'----TQC--- --!�li--r�._��_�------------------------------------------------------ ---- Phone------------------------------------ 1 --------------------------------------------------------I-------------•------------------------------------- -------------- --- --------- Contractor's !Name----�XAD5 �--•_ -e� _.__�_& 5X r ill['� - -- ----- - -- --- -- -----. Phone--- r Installation will serve: Residence © Apartment House ❑ Commercial p Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ___._t_ Number of bedrooms ---3- - Number of baths ---I--- Lot size -_____]_0-YX/ice ' Water Supply: Public system Q Community system ❑ Private ❑ Depth to Water Tableyd-- ft. Character of soil to a depth of 3 fee+: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe�q Hardpan ❑ Previous Application Made: Yes ❑ No - New ConstrucFion: Yes N '� E o ❑ FHA/VA: Yes ❑ n No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS- - (No sekic tank or'cesspool permitted if public sewer is available within 200 fee+.) Septic Tank: �_„ Distance from nearest well_________________Distance from foundation--_____---___ ❑ .....:r -----.Material------------------------------------------------- ,,.; .,I- No. of compartments--- ----------------Size-------•------------------------Liquid depth---------- -- -----Capacity- `Dis osal Field istance from nearest wel!--------------_ _.Distance from foundation-----.--------------Dis#ante to nearest lot line________--_---_- Number of lines------------------------------------Length of each line-----------------------------.Width of trench Seepage P;ifi , Type of filter material_________________________Depth of filter material----------------------- otal length •------------ Distance to nearest welhi&R(-----------Distance from foundr� . ation__ �-- ......Distance to nearest lot Number of pits--------I------------Lining material_P_-P -------.Size: Diameter_ -'------------Depth_...!;47i Cesspool: Distance from nea:est well_________________Distance from foundation____-__--___.---__..Lining ma#erial_----..______.__---______-_- ❑ Size: Diameter Depth ------ ------------------------------------------Liquid CapacitY--=---------------------- galst Privy: Distance from nearest _ well__________________________ __`____-.____-__ g-----Distance from nearest building jj ❑ Distance to nearest lot line_______________ - 4 ------------------------------------------------ Remodeling and/or repairing--(describe) = = ----------° ------------------ --------------------------------------------------------? --------------•---------------------------------------------•--- .: ----------------------------------------------------- -------- ---------•--------------------------------------------------------------------------------------------------------------------- --------- 1 hereby certify that ! have prepared this application and that the work will"be"done`in accordance with San Joaquin County ' ordinances, ------- laws, nd rules and regulations f the San Joaquin Local Health District. (Signed 9 )----------------- ------------------------Owner and/or Contractor) By:----------------------------------------------- I-----------------f + ilTitle .____ (Plot plan, showing size of lot, location osystem n relation to wells, buildings, etc., can be placed on reverse side) tt -- I I FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY....------.. R_,_C ---------------------------------------------------------------------- DATE--------- ��- ' , REVIEWEDBY------------- ------------------------------------------ ------------ ------ DATE----------------------- UILDING PERMIT ISSUED-----------------'t --------------------------------- - ------------ ----------------------------------------- --- ---------- . --- ----- DATE Alterations and/or recommends+ions: --- ------------------------- ---------------------------------- 14-----�----- YAN-K� -----__--------------- --------- ------ -------------- ---- ----- - - ------ ----- -- ------- FINAL INSPECTI Date--------- --_`+_ " ------------------------------------------- SAN --- SAN JOAQUIN LOCAL HEALTH DISTRICT `I 130 South American Street :300 West Oak Street 132-Sycamore Street 814 North "C" Street i Stockton. California Lodi, California Manteca, California Tracy, California i C ES-9-2M Revised 1.57 EP.CO.