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�rAPPLICATION FOR SANITATION (Complete in Duplicate) __PERMIT �'� Permit No. ----- _-Z�- Z— A Ilea iortlis hereby mad�� L Date Issued ___ � ! z � '4". Pp + to the San Joaquin Local Health District fora permit to construct and install the work herein described. This application es made in compliance with County Ordinance o. 549. J08 ADDRESS AND LOCATION ------------ Owner's Name------- -- ' -- ` Address--- 3 ��h-GL-_Gz- -�,� one-----------•--------•------•-------- -- P :.. Contractor's Name---------- _ _S__- . � _K_s -,�..1 --- -----•-- --- --- ------•-......• Phone_-_----•------------------•---•---• Installation will serve: Residence [Apartment House ❑ Commercial ❑ Trailer Court ❑ Moil ❑ Other ❑ Number of living units: _l--__ Nurnber of bedrooms .3-- Number of b s Lot size .-_ - ---- Water Supply: Public system ® Community system Priv ' ` y Y ❑ epth to Water Tabled._�sff. i Character of soil to a depth of 3 feet: Sand Gravel ❑ Sandy Loam Clay Loam E] Clay ❑ Adobe[I Hardpan ❑ Previous Application Made: Yes E3No New Construction: Yesto ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank'or cesspool permitted if p blit sewer is available within 200 feet.) ` r Septic Tank: Distance from nearest wella -c+P---Distance fro foun dation v e r Material-- A No. of compartments_----- ---- ---- - - -- ------Size-- �.___Liquid depth_."--_ - CapacrtY �___ Disposal Field: Distance from nearest " "-_ Distance from foundation-- -� --- - " Distance to nearest lot line__ r-W".-"— ® Number of lines _- Length of each Iine,,,;lQ-- 5' -—W"--"— Length Vidth of trench-"--_.V-1? Type of filter material-_ Y_ _- -- _ Depth of filter material-- ` -------------- --�---------Total length--- /,X - Seepage Pit: Distance to nearest well-------------- ____Distance from foundation--------------------Distance to nearest lot line ❑ Number of pits--------------------`Lining material--------•"---- -- -- � -.- sancefoundation ----Size:`Diameter--------------------Dep#h- --------------------------- Cesspool: Distance from nearest wel-__._._-"--_- D - rI Ef from foundation_______________ -_._,Lining material__.- __--"__- _ Size: Diameter-- ------- ---------.............Depfih_-----=�----- - --------- -- ----- ---- 4 ------Liquid Capacity---------------------------gals. Privy:, Distance from nearest urell-____---_____________________ _ -_ Distance from nearest building Y , g = - ❑' Distance #o nearest lot line-.-.__._ , ---------------------------------------- Remodeling and/or repairing (describe):_"-____----------- --------- ' --------------------------------------------------- __________________________________________________ --------------- I hereby certify that I have prepared this application and that the work will be done in accord ordinances, Stafne laF nd rules and' egulations of the San Joaquin Local Health District. ance with San Joaquin County (Signed)- [cz --- . --------------- -------- - ----------------- - - --------(Owner and/or Contractor] By:-------------------------------- ----------------`------------------------------------------- --- --- ------ •-- ----- T (Plot plan, showing size of lot, location°of system in relation to wells, buildings, etc., can be placed on reverse side). i F R EN SE O Y _ fi APPLICATION ACCEPTED BY-... r ------ TE----------- -------- -----� , REVIEWED BY-------------•------------- r- ----------------- ---- --- -- - ---------- ---------- ------------ ------ BUILDING PERMIT ISSUED DATE__.-. Alterations and/or recommendations:--------- -- _.. DAT BUILDING ---- .............. -------- " . . ----------------- R - -- --------- ---- - --------------------------- ------------------ -------- -------------------------------------- ------------ " V- Z --------------------- ---------------------------- FINAL INSPECTIbN�BY:s. Date. w --��---,- -------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT ' 130 South American Street, 300 West Oak S+ree+ ,132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California "Manteca, California Tracy, California 115446 ATWnUD- ely-54_, f