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e �,.��,�u„�,��""`•P APPLICATION FOR SANITATION PERMIT Permit No. ..... elt /-- ---. e iFr (Complete in Duplicate) Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This ap lieatiori is made in compliance with County rdinanc No 9. 2�I U 0 �-0 f � Mr 1r11E57"6F q! °! FGE. Crf erl�tf rt0�J� /� ®� /�� WYY JOB ADDRESS AND LOCATION (1"(�!�-_ ._.��GvcfL�. .. - - --.. f�l ../YE. ---- -------- -•---------------/. e Owner's Name. R: i94`�`E../I� r�... —`.� ..../-Ll.-�'t�r9 Q�r�- �Ut.lOff r---------- PK ne.111- 7--- Address----------------tfzz .....YY-._._y_�F ��/------A-Y --STO�KZ"0.�✓_...-_4-°/�:�:----........./ G... e Contractor's Name--------------------- 7- .IR.R.I:S{.�.........1 r&4-------------------......_..-......'-----....-_.- Phoney.lrJ.."..C�.�.C.44.4'7- Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other 29�MP Number of living units: ------- Number of bedrooms -------- Number of baths ........ Lot size ..1¢C :.. -^-..---.••_... -..----.---- e Water Supply: Public system ❑ Commur ity system ❑ Private P Depth to Water Table;Z-- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam❑ Clay Loam(Z Clay ❑ Adobe❑ Hardpan ❑ e Previous Applicafion Made: Yes ❑ No X New Construction: Yes X No ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) r A. p� Septic Tank: Distance from nearest well.�.......Distanc frorn {oun gtion....:d............ teriaLl:\6e.gWiQp -..-OCC ota e ® No. of compartments................._Size/�X.�----- .Liquid depth._ -----....____Capacitys..._._.i fa r Disposal Field: Distance from nearest well.wSS_......Distance from foundation..1�.__....__Distance to nearest lot lir1p..2 0....._. e Number of Iines..J0..g .,r.............Length of each line. IQ.G�...�p rt Width of trench...�l ..r.........----..__. Type of filter material 7. li?OC/{-Depth of filter material..../.b............Total length...�� ..�-Q...................`... i / Seepage Pit: Distance to nearest well 1�6r�........._Distance fro, _fou da fion__//%!7._...Distance tonearest lot ling.----- Number of pits---•,..............Lining material. fE1L°KeSize: Diameter-13,3............. Depth_../Z------------_----- e Cesspool: Distance from nearest well.................Distance from foundation._-_..------------Lining material.-_................................ ❑ Size: Diameter..... -..... .... -r ........Depth.............._........................-------.._..Liquid Capacity............................gals. e Privy: Distance from nearest well.................................................Distance from nearest building.......................................... ❑ Distance to nearest lot line...............--------------------........... -- ..........---------------------_.-------------------------------------------- Remodeling and/or repairing (describe):-- ---.--... '............. ............._. ...-....--- - - ------- .-- - ------------------- ..........-------- _--•----....aq in------....... e I herebyy certify +ha ve prepared this application and that the work will be done in accordance with San Joaquin County ordinance,, State laws, nd r legs and regulations of the San Joaquin Local Health District. Sr ned _ - . - ✓��`�_l-J-.y-..<f`lv ' - -- --- Cwner and/or Contras+or) -J� (Plot plan, showing size of lot, location of system in relation to wells, buildings, ate., can be placed ` serene side) FOR DEPARTMENT USE ONLY eAPPLICATION ACCEPTED BY -....... -- ... ..... - ... ------------------------------------- DATE.----------- --_� REVIEWED By--------------------------- DATE _..... .......... - ---- .....................I.......—....... DATE......-. ./...I....-------------..------------ - e BUILDING PERMIT ISSUED------- .......h&Q . ....... Alterations and/or recommendations:---. - -.--......-------- - ................................................... -....................................... ...----- ----f�-l--- - --- -- -- - _ n`' ---------- ---- ... .........._.............- ------.. -......------- -..... ...1.... .. .. ------------------- FINAL INSPECTION BY:.... .....� .....,� -. Date...._-7y...6. ........._.......................... e SAN JOAQUIN LOCAL HEALTH DISTRICT e 130 South American Street 300 West Oak Street 132 Sycamore Street 014 North "C" Streef. Stockton, California Lodi, California Manteca, California Tracy, California ES-7-2M • Reviseo 1.57 F.F.CO•