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P f s7 APPLICATION FOR � �� SANITATION PERMIT Permit No. .2.Z--- > (Complete in Duplicate) S Date 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 ATION06IV Owner's Name - -- - ------------Pho !'-- ------------------ -- F-4,55A---u-o- Le--------------------------------------- ----------- -------Address --------------- -----------7---------- Contractar's Name s' a 1'�--II q_�-•�, �/ oN� -- �r- Phone Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ j Number of living units:rdH6 Number of bedrooms _,i--- Number of baths OA6-Lot size - 4-- S`�____-- Water Supply: Public system ❑ Community system ❑ Private X Depth to Water Table,26' ft. r Character of soil to a depth of 3 feet: Sand ❑ Gravel Sand Loam Clay Loam Clay k ❑ y ❑ Y ❑ y ❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑ ,� No New Construction: Yes ❑ No y, TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well-----------------Distance from ❑ foundation-------------------.Material_-_------__No. of compartments--------------------------Size--------------------------------Liquid depth--------------------------C-_a_-_a_-c_i_t- Y-------------------------- Distance ------______-____-____ Disance from nearest wellDisposal Field: ----------------- .Distance ---------------- � _ istance from foundation--------------------Distance to nearest loft line-------------_ - -- ❑ Number of lines- Length of each line -----------.------------Width of trench Type of filter material-------------------------Depth of filter material----------------------- length-------------------------- - fr ---------- Seepage Pit: Distance to nearest well-/0Q__________Distance from foundation---(0_____________Distance to nearest lot line---- Number of pits-_0 --------Lining material_391! �___--Size: Diameter r------------De th- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material-_--_---__-------_---_ Size: Diameter--- W-----------Depth------------------------------------ ---------------Liquid Capacity----------------- --gals. Priv --� _ V -- - ---- Y Distance from nearest well--_-°_____-----__ __ ______ -- ---___Distance from nearest�uiloing:----_.--"_--___ m_-;_ El Distance to nearest lot line_--- ---------------- -- - ---------------------------------------------------------- ----- --------------------------------- Remodeling and/or re airing (describe):-__---_ _- D-L_7lO /_------_ ----------- _ - � ------------.- . -------------------------------------- ------------------ I— ------------------------------------------------------------------------------•----------------------------------------------------------------------------------------------------------------------------------------------- ! hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquirf County ordinances, State laws, and rules and'r lations of the San Joa in Local Health District. f] a (Signed)....._ 1 /-__ Q �'--------- �t _ -1- IT tc_as �1/�'r- -----�/ k--- (Owner a /or Contractor8Y� � ----------------------(Title) ) (Piot plan, showing size o lot, location of system in relation to welts, buildings, etc., can be place on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---- ----- DATE_-;�-___•__•-----_---- -------------------------------------------------------------------------- REVIEWED BY --- DATE 9/ ---------------------------------------------------------- BUILDING PERMIT ISSfJED------------------------------- ------------ - ---------.- DATE............. -_------ ------------------------------------------ Alterations and/or recommendations------------------------ --.-,- a --------------------------------- ----------------------- -- - ---•------------------------------------ FINAL INSPECTION Date--- ;. - ------------------- SAN '-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 —9-2M R-51 Revised W-2100