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+fir'. ti C` •"tet ..J� ! V^ f� U 1 — l v -�.' c _.,. APPLICATION FOR SANITATION PERMIT Dern No. _3-1_O--- 0 S (Complete in Duplicate) ' � � Date Issued _-_ Y u c. 77 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__ ._S �--- - --� t1-- ----1F- ----/— ----- -- Owner's Name_ (��- >-e'''T,1 �- --- K. ------------- -------- - ---------- Phone-------- -------------------------- Address------------ " /Cf. y _ _=_ .. 7 r Contractor's Name--- �,- o P7-4 - f. , -: ---- -- ---------------- - --- -;�' _(----- Ph n� Installation will serve: Residence [+art Apartment House ❑ Commercial [] Trailer Court ❑ Motel ❑ Other F].) a C7 /tea. Number of living units: _umber of bedrooms __ -__ Number of baths - ___ Lot size _____,�t'--__________ --(--'_____________________ 4 f Water Supply: Public system Community system ❑ Private ❑ Depth to Wafer Table -------- ft. Character of soil to a depth of 3Ifeet: Sand ❑Gravel ❑ Sandy Loam ❑,Clay Loam E] Clay E] Adobe [ -''Hardpan [jPrevious Application Made: Yes E] No [A New Construction: 'Yes —No ❑ ' TYPE OF INSTALLATION A,D SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank:, /� Distance from nearest well_________________Distance from foundation-------------------- ( No. of compartments --- 5i e--------------------------------Liquid depth Capacity ..rC p �� q p --------- Disposal Field: Distance from nearest �l��_Distance from foundation__��----------Distance to nearest lot line__U._-______ E� Number of lines__-____( ` �--f A4-----___ Length of each line___ --___ --___.Width of trench____ /� Total len fh_ Type of filter material-�_Jf:QrDepth of filter materral___�__�______ '�___________________-_ .Seepage Pit:'— Distance to nearest well-AOru'4 -----Distance from -foundation__74_______._.Dista.nce to nearest lot line--- t � % E'� Number of pits---CS`l_� '.4____Lining maferial__: I�,J:..r-Size: Diameter_,:..-------------Depth-__._____�_� Cesspool: Distance ;from nearest well----------------- from foundation--------------------Lining material______--__-__-__________---_________ 4 ElSize: Diameter--------------------------------------Depth----------------- --------------------------------Liquid Capacity----------------------------gals• Privy: Distance from nearest well------------------------------------------------Distance from nearest building------------------------------------------ I I ❑ Distance to nearest lot line------------------------------- --------------------------------------------------------------------------- Remodelin and/or repairing (describe): -_ __ 4y_f ..... - �-_ �� _ .r _ �1 g / p g ( ) r = '' - --------------•----------------- ---------------•--------------------•---------- = ! /_a = —------ ---------------- - -f ----------------------- ------------•----------------- ----------------- ---------------------- ----- 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. F (Signed)---- --- - l =�_ ! _- � �=° -----�-�;-•-• - -� ------- --�- �---- -�� - �s.- -- - �-��"--�.�_-- X_ (Owner and/or Contractor) --- BY:-------- - _. - -------------------------------- - - ( 1 .- ---------------- -�---- - -- - ----- ---- --Title----- �'..- _�r�C�• (Plot plan, showing size of lot, location of system in relation to w)iis,' buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY Y APPLICATION ACCEPTED BY---------- --------------------------------------------------- DATE REVIEWED BY ------ • --- -------�-- "'' --------------------- DATE I ` ---------•------- BUILDING PERMIT ISSUED--------------------------- --•--------------------------------------------------------------- DATE Alterations and/or recommendations:--------------------------------------------------------------------------------------------------------------- --------------------------------- ----•------------------------------------------------------------------------------------------------------------------------------------------------------------------------ -------------------------- FINAL INSPECTION BY:-------- • = -------------------------- Date------I-A.1-to-j- _ .e. 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 E5--9--2M 8-51 Revised W-2100