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y✓ APPLICATION FOR SANITATION PERMITPermit No.p�,.--�_'_ { (Complete in Duplicate) - Date Issued __9�7�S_16— F 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 Ordinance No. 549. 1 JOB ADDRESS AND LOCATION2-64 -------- V t ---------- { _�_ _ _ ---------- -- ------- -------------------------------------- ------ ------------------------------------ Phone__ P t Owner's Name______ -- '----- Address------------•- ------- �y�'� '/ --------------------------------------------------------------------------------- Contractor's Name_.-------D-o---�--+'---{------?--/�__i:_l._i�_�•_�_r1 - ------ �.?01L!�� f_L�_.�, Phone� T��7 t Installation will serve: Residence g Apartment House ❑ Commercial ❑ Trailer Court ❑ry Motel ❑ Other ❑ Number of living units: _I_ -- Number of bedrooms .Number of baths _Y7Lot size _'I_-5:___X____3 __________________________ ' Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy loam ❑ Clay Loam ❑ Clay ❑ Adobe �" Hardpan C]Previous Application Made: Yes E] No X Now Construction: Yes F1 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_gd Er_Distanc% ]' fromrfoundation__-,-2--^�e___.Mate`_i_al.__ --- ------ -;y ______ No. of compartments-_�---------- ----- eLiquid depth__�A_ ___________Capci Disposal Field: Distance from nearest well_ j''Z._.Distance from foundation_______. _"____--.Distance to nearest lot line-Z-0 �A__ ___________Length of each line__ �_-------Width of trench__,�- _____------------- Number of lines____' ` Type of filter material QCt Depth of filter material____ _-_-_______Total length__ a`S------------------------- Seepa a hit: Distance to nearest well___,*___.Distance frorry fo ndation____ l .�,___..Distarce to nearest lot line-- --------- S Number of pits__LPI—R.--_____Lining material___ __. ize: Diameter_ __---------- .Depth__ S______________ ____ Cesspool: Distance from nearest well_______________ Distance from foundation--------------------Lining material----------------------------------- F1Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity----------------------------gals. . Privy: Distance from nearest well____--------------------------------------------Distance from nearest building-----------------------------___-------.0'� Distance to nearest lot line -'Ie------------------------------------------------------------- -td-,� Remodeling and/or repairing (describe):-- - '-... -- ------------------•--------------------------....--------•----------------------•----- .--- I— � � � �; --- --------•-•--------------------.....--------------------------•---•--------------------•------------------------------------------------------- .--------•-----------------------------------•----------------------- hereby certify that I have prepared-this application and that the work will be done in accordance with San Joaquin County ordinances, Sta"_ws, and rules and reguldtions of the S 4i Joaquin al h District. ... r --- - - --- - -- - --------------- ----- - --- - ----- ---- -- - ------ (Ow and`/ Contractor) 4 (Signed)--- �f.__----- ----- ---- ----- �-- - ner " 13 - -------- - --------L/` '-------fon ---- ----- --- ------------------------(Title)------- - - - --�_ �� ----------- Y (Plot plan, showing size of lot, location of system in relato wells, buildings, etc., can be place on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------------------------- ----------------------------------- - DATE----------------- S--� ------------------ REVIEWEDBY----------------------------------------- -- --------- -- ------------- -------------------------------- DATE---------------------------- ------------------------------ BUILDINGPERMIT ISSUED---------------------- �------ = ---------------------------------- -- DATE------------------------------------------------------------- Alterationsand/or recommendations:----------`---------'------------------------- --------------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------- FINAL INSPECTION BY:-------VLC- ✓ ---- Date------- `5 I r f SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M. 8-51 Revised W-2100