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# APPLICATION FOR SANITATION PERMIT Permit No. A-i- - :- k (Complete in Duplicate) 1 J Date Issued ---- ------f- -7� Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. , I This application is made in compliance with County Ordinance No. 544. JOB ADDRESS AND 'LOCATION------.19 ---------------------------------------- Owner's Name__AX!tJ1gr'_ 1-t-9------------------------------------------ ----------------------------•------------ Phone__9_-r9_82S----------------- Address...AeLMe-----=------------------- - - ----------------------------•----------------••---------------•-•-------------------- -•---- Contractor's Name---------Ae1 a-------------------------------------------------------------------------------------------------------------------- Phone------3!n39L35_ ------•------ Installation will serve: Residence [] Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __1__- Number of bedrooms -----?_ Number of baths ------1 Lot size -----51 x1-`,0-------------------------------------- Water Supply: Public system [8 Community system ❑ Private ❑ Depth to Water Table -25_ ft. Character of soil to a depth of 3 feet: Sand E] Gravel ❑ Sandy Loam [:] Clay Loam [j Clay E] Adobe® Hardpan ❑ Previous Application Made: Yes ❑ No ® New Construction: Yes ❑ No [73 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--------------------Materia4.______:___-_____--_-_._-______________________. E 110ING No. of compartments--------------------------Size--------------------------------Liquid depth-------------------------Capacity---•------------- ---- Disposal Field: Distance from nearest well------------------Distance from foundation__________ --------Distance to nearest lot line________________. EKISUNG 'Number of lines-----------------------------------Length of each line------------------------------Width of trench------------------------------------ Type of filter material-------------------------Depth of filter material-----------------------Total length------------------------------------------ '--' ______.Distance to nearest lot line____ _ Seepage Pit: Distance to nearest well__ 0 _______Distance from foundation----i ___.._ L ---- [N Number of pits_.___I______________Lining materiaL___brl mak___-Size: Diameter___-__�!____r______-Depth------- ___"Q__________ Cesspool: Distance from nearest well-----------------Distance from foundation------ -------------Lining material-------------------------__________-- ❑ Size: Diameter-------------------------------------Depth----------------------------------------------------Liquid Capacity----------------------------gals, Privy: Distance from nearest well-------------------------------------------------Distance from nearest building-------------------------------------- F-1 to nearest lot line--------------------------------------------------------- Remodeling and/or repairing (describe)-------------------- ---------------------------•--------------------••------------------------------•------•- ------------ ---------------------------------------------------------------------------------------------------------------------------------------------I---------------------------- -------------------I——----------------------- -------------------------------------------------------------I--------------------------------------------------------------------------------------------------------------------------------------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. w (Signed)-----------------Pelt4--------------------------------------------------------------- -----------------•---------------------------------------------- .--(Owner and/or Contractor) -y peer- Warth,�i.n (Title)_-_-Qwner-M x (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 APPLICATIONACCEPTED BY---- ----^ ----------------------------------- DATE------------------------------ - ------------------------ REVIEWED BY--------------------------------------- DATE- /_/-f �� 71S BUILDING PERMIT ISSUED /` DATE -------------------- Alterationsand/or recommendations-------------------------------------------- ------ -------------------------------------- ----------------------------- ------------------------------------- y -------- ---•----------- ------------------------------------- --------------------------------------=------------------------------------------------------------------------------------ 1 °---- ----------------------------------- ----------------- ------------------------------------------------------------------------------------------------ I --1--- `------------------ '----------- - --- ------------ ----------------------------------------------r------------------------------------------ FINAL INSPECTION BY:3_-�� -------``- ---------------------- -------- --------------------------- SAN JOAQUIN1OCAL-HEALTH DISTRICT 130 South American S}reef 300 West gak�Street , Y••132 Sycamore Street' $14 North C Stree+ Stock}on. California Lodi; California 'Manteca;''.Califarnia Tracy, California ES-9-2M 8-51 Revised W-2100 ' "