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} �t s, APPLICATION FOR SANITATION PERMIT . Permit s - (Complete in Duplicate) V/ 1 3 `d 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 application is made in compliance with County Ordinahce No. 549. P JOB ADDRESS AND LOCATION________ --------------------------------------------------------------------- Owner's Name -• Address------------ '"� .�-. ---------------------------------------- Phone-I `f"-/l` - --------------------------------------------- ----------------------- ontractor's Name-------- - -------•------------------•----------- ---------------------------- f Phone - -//'-•- Installation will serve: Residence F Apartment House ❑ Commercial . ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: A-__ Number of bedrooms__- Number of baths --- ---- Lot size _-�-�j1_w, _ Water Supply: Public system E] Communitysystem "" Character of soll to a depth of 3 feet: Sand ❑ Gravel ❑PrlSandyvate �LloaDe�h tClay Loamo Water E] Clayft Previous Application Made: Yes No ❑ ❑ AdObe Haparr❑� ❑ ,� New Construction: Yes ❑ No � - 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-_• Cf------Distance ,from foundation____ 1-0-------.Material---- No. of compartments_______-7L.-- __--__ Size_---.I_ _y�, _1S_ Liquid depth---- - ---- Disposal Field: Distance from nearest well ----------Capacity.__1_ 7� �p. -- Distance from foundation---/a-__------Distance to nearest lot line____-______ Number of lines-----I-----� ------------ ----Len th of each line__ __ g _ �"X' •_ �1.Widfih of trench--9_�� ------- Type of filter mafierialf_,t -' u _ Depth of filter materia!____J_ " Total length_______/SSS" ` Seepage Pit: Distance to nearest well-----------------------Distance from foundation--------------------Distance to nearest lot fine---------._._,.__ . ❑ Number of pits______________________Lining material----------------------- Size: Diameter ---------------.Depth------------------------- Cesspool: Distance from nearest well-----------------Distance from foundation__ ------------------Lining material____-._-________--__-___-_ ❑ Size: Diameter -__._" ""-- . Depth • --•- --- -- --- -- Liquid Capacity-- PrivY: Distance from naresF=well -`� " gals- :. _ — .�--� ,� .��. El Tstance fromvneatest�buildin` �----a Distance to 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 accordance with Sart Joaquin County ordinances, State laws, and rules a d regulations of the San Joaquin Local Health District. (Signed) Q� w B . Cf ----------" ------------____-(Owner and/or Contractor Y•----------•----- --- ----------------F--- ---------------------------------------------------------------- Title --- ( (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., canbe placed,on reverse side}. } FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_______-- 117 --_ _ 'i-- DATE------ ---� ----- _,_ REVIEWED BY--------------------------------------------- � � � ��------- ------- - --------------------------------------------------------- --- DATE BUILDING PERMIT 15SUED------- -------- ----------------_------ ---------- -- - ------- ----------------- ----------=---- - Alterations and/or ecommendations:------- 1 ` .- DATE-----------A--------------------- ---�' = ---------- i --- -� � , - _ .- - ---•----• f �- --- --------------- -------------- ----------- ------------ ------ M • -_--�Lf_ - -- -------- ------- ----- - - --- ..--- ------- _ ��--- - ------ �._�---�------._-G-��-----�--- -rte .--- -- FINAL INS EC�TIO (' s r K!& Z4 1 Date �1,?_1� - 1SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Stre�ef'^^ 300 West Oak Street 132 Sycamore Street Stockton, California 814 North "C" Street Lodi, California Manteca, California Traey, California LS-9-2M 8-51 Revised W-2100