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APPLICATION FOR SANITATION PERMIT Permit No. _4_a_sZ_ (Complete in Duplicate) j` Date Issued /-- Applica-�ion 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. f"71 dF'Z ,-LUSFCry✓ . c.✓+1 �!� ; f S'—(UU—C��' JOB ADDRESS AND LOCATION...��-----�..,_-.�0�"-_22":"""L�naen"""-_`------------------"""-- ;��- h Owner's Name-------AI- lgTriiri� -' ------ --------------------------------------------------------------------` 24F Phone-. -9-F- J---Lindy -A r 4 Address__Linden""Rd". "fin Dun"cin---RC!-- --y--P-•-G......---'tr n�'---ori r.--- -turn"_S - � a Contractor's Name-"-to 3. Ma'�.,1 baxee turn towa.'rd Stkt n 1./10 mile to �pt house on --- DUIL a'l----Inu---- ------------------ - ------- ------- ---- --------- --------------- one---•�r--�-�.0 J---••---- Installation will serve: Residence ®+Apartment House ❑ Commercial ❑ Trader Court ❑ Motel ❑- Other ❑ � Number of living units: _1---- Number of bedrooms ----2- Number of baths1!-—Lot size .--"2G"-""._-"""_"...-"_"".__" " Water SuPPIY� Publics stem ❑ Community system ❑ Private � Depth�.#,to Water T$able "j-Q__ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe K] Hardpan El.. '0 Previous Application Made: Yes [-] No 91 New Construction: Yes ® No ❑ F 1 w , TYPE-OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is avai[able within 200 feet.} + 1 Septic Tank: Distance from nearest well__:."-_____-_--"Distance from foundation_-:_-___"""____`..Material------------- ------------------- - ------ . e3 � � i17� No. of compartments Size--------------•---------•-------Liquid depth-----------I-------- --.-Capacity----------- Disposal Field: Distance from nearest well-----------------Distance from foundation_':�--:---__.----`-.Distance to nearest lot line, -------_""".. ' eX. ng Number of lines----------------- - --------------Length of each line-_------------- ---------------Width of trench i Type of filter material-------------- "------_-Depth of filter material-------------`--------Total length---..------------- .-----------.__ {c� Seepage Pit: Distance to nearest well_10-0_------___!_ 4 -----'= - 1 Q_1__ 1 t �------------ ---Depth__.--��'--,�,��------- Cesspool: ---�� © Number of pits.-.:----i+---_-_Lining•mDateraalber CX foundation €haef r___ Distance to nearest lot lin�e_,�__ __ T ri Cesspool: Distance from nearest well _?-__-Distance,from'foundation--_—__:_f_.I... Lining material--_--_----.______"-.____ ,,_,-____- • ❑ Size. Diameter- {----------- -----"u_Dep th---- ---.-----=--=- ----------� -----------------L�quicl Capacity 9a. fi .,. Privy: Distance from nearest well-----..---.____--------.- ----------------Distance from nearest building -------------------- ❑ Distance to nearest lot line---------------------------------------------� - k FA Remodelind and/or repairing (Jescribe�--------------Aa 149---s-PEP&fie _1J"1t_ to eX�,S'tZnss g em ! ! of x -----•-•----------•-------------•------ i -- .. g - -------------------------------- -------------------------------------------------------------------•----- 1 = "v------- > I hereby certify that I have prepared this-'application and that the work will be done in accordance with"San Joaquin Coun4 ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed)-------- ----------- Del In C; I fi (Owner � . _ = = = --------(Ow and/or Contractcrr)f "--Wa.rtheD--------- .�` ...,......,....,,,..... ' - .. �. . -------- ------ --------------------------------------(Title)...Gen Mir,.-----.------------- (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 :,y3 APPLICATION ACCEPTED BY- ; --" -_ QS' T -- - - - - - ------------------------ ----------------- - - - - - - - REVIEWED BY DATE----- ----• -- --------------------- ------------•--- BUILDING PERMIT ISSUED Alter, ----------------- -- --- ------------------ ---------------------------------- DATE----- --- Alterations and/or recommendations:_....__ -- -----.�--------""� _ - --- . ----------.---- .-.._------- - ------- - - - --------------------------- ------------ FINAL INSPECTION BY.-----_ -_-- -." Qate__.-- �� - ------------------------------- ------------------------------------- SAN -=- ----- ----SAN JOAQUIN LOCAL HEALTH DISTRICT X130 South American Street 300 West Oak Street 132 Sycamore Street814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ' ES-9-2M s4s446 ATWO0 12-54