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APPLICATION FO - R SANITATION PERMIT Permit:No.-�."z (Complete in Duplicate) "---- ' Date Issued ----------- Y - � Appfication�is-isSan J�o�aquin`"L'cical Health Districfi fora ermit- t This application..is made in compliance with County Ordinance No. 549. P.; ' ' 1�0horOBD scram f P to_construct end'install'the work herein described. JOB ADDRESS AND LOCgTION._ gi' /7 = ' .-...�A } 'r �-� 77 Owner's,Name------------ � -------•--•-- --- -------------- --- •- `----• -- -------- Address - ----------� �,_ ' � 'r c?, :'. ------------ Phone--= s Ila}itor's Name----- , U "� C` . _IE67 C � on will serve: Residence p = %� }" Phone- -- � � ❑ Apartment House -•-----------•--•�' ❑ Commercial ®' Trailer Court ❑ Motel ❑ Other ❑ Number of living units: j" Number of bedrooms Water FSupply: Publics stem � - Lot size.--- c i't_ / f Number of baths ___.___ Y ❑ Community system,[] Private P. Depth tc Wafer T ble _ l" ft• Y Character of soil to a depth of '3 feet: and El' Gravel ❑ Sandy Loam ❑ Clay Loam Previous`Application Made: Yes . . ❑ Clay E] Adobe Hardpan ❑ ❑ , ew'Construction. Yes ❑ No:O TYPE INSTALLATION No K NAND SPE61FICATIONS: �) (No septic'tank or cesspool permitted if public sewer is available within 200 feet.) Septic'-Tank: Distance from nearestfwell" _ © + Distance from foundation---- No. _""•-_-Material._____ ' %!1 >� No. of compartments ` Size== ... ��.�.-f�---liquid depth_._��--��' t, �'��ll�---- Disposal Field: Distance from nearest well--- ---�_ ------Capacity "";� ,� 'D �Dis'`anceotnoundation.__. __ Distance to nearest lot line__`7J� Number,of lines_==%_ .- 1 - L Len' th eack�'line =-- !__. . , VVidtli'of` - Type or .fitter ma#eriaf.t'�?: " Depth of filter rim-aterial___"Ift' _ -------Total length"----------1{-'--- Seepage Pit; Distance to nearest well_____________________Distance from foundation____.--------------- ❑ - Distance to nearest lot line______________ Number of pits_____________________Lining'material--------.:_-------------Size: Diameter---------------------- __ Cesspool: Distance from nearest well________________Distance from foundation--_--•------" Depth ❑ ( Size: Diameter---- -1------------------ - Depth.._ - material 'r',.^'--,�:.�a==-,. w,�-_- _,— . -------- p Lining --- --•-- ---------- Priv .- v ¢._ --------------------------------------Liquid Capacity ---els. Y Distance from nearest weltr_ """'�'"'"11 J� -_- -------- _ .,�, 9 _____________Distance from nearest buildin Distance to nearest lot line__ } --=---------------------- - - ---- g -Remo - - --------- -------- -- deling and/or repairing (describe):.----- �� •�' , ��'��- ��/c�lFF 3 ! f -------- �d ---------------------------------------------7------------------------------- ----------------------------------I P P --------•----------•---------------------------------•------------•------------------------------ < I hereby certify that I have prepared this application and that-+he work will be done in accordance with San J ordinances, State la s, and r les nd regulations of the S n Joaquin Local Health District. Joaquin Caunty� (Signed) _._ ----- ------ __ - l irr..�-cii - ---.. ---- - $.y:---------- -- -- i�i' � `: -� (Owner Contractor) or) -------(Title)------- ----- ? (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 APPLICATION ACCEPTED BY_______" _____"_ REVIEWED BY-- - = _ . -------------------- DATE / S BUILDING PERMfT ISSUED -- ----- ---- --- - DATE__-'_-_ ------ erations and/or recnmmendatians:_____.,_"-___"-_ " ----------------------------------------------------- DATE------------------------------------------------------------ --------------------------------------------------------------------------------------------------------------- " ----------------------- --------- ----------------- • = r ---------------------- - -- - -------- FINAL INSPECTION BY:__. _ " - ......................................... -------- ------ ------- Date ------- ---• ----------------------------- JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street CLo�dL t Oak Street 132 Sycamore Street Stockton, California California 814 North "C" Street Manteca, California Tracy, California ES-9-2M B-51 Revised W-2100 1