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\\ APPLICATION FOR SANITATION PERMIT Permit No. .-.Q_-d .... (Complete in Duplicate) / Date Issued ------{...y.- 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 nmaade in compliance with County Ordinance No. 549. ISS7cSr, JOB ADDRESS AND LOCffATION- - (I�r=---/)— --- � •- '-- ! _f �, _ Owner's Name------------- !01Y-41--------- _l r - ---------------------- - ------ -- -•- -------------- --- Phone - ------------ ------ -- Address----•----------- ----•--- _ d� �:/-------------------- = J - . ----------------------- ---•---•---•--- Contractor's Name-------------------- -000- - ' x��.�Lr '---- sev-Y/-e------------------------------- Phone----•---•---- . T Installation will serve: Residence R�—Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of livingunits: .f_ Number of bedrooms q-- Number of bathsq_' Lot size --- �f5 Af ------------------------•------- Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table ! " ff.. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Rq"~Hardpan ❑ Previous Application Made: Yes ❑ No g�- New Construction: Yes 8-110 ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest w ll --_--.D• tante f1pm foundation - _ Matercal-_ _ -. .- No. of com artments. -"._} i� -,r r� p e J � -_ Liquid depth f�" Capacity j` ----'�-D- Disposal Field: Distance from neares _well_+-+�-.r---- stanc trom foundation-4 -.-_....Distance to nearest lot line._ __- Number of lines----,- _ Length of each line- _A1"+ �`� ®� - ----�--- ------ -- -- - 9 -----� �_ .�� 1Nidth of trench.-----��•�---- ---------------,.. Type of filter material1 .,ke Depth of filter material....Af.. .--. Total length--_: Seepage Pit: Distance to nearest well_._a p-------Distance from foundation-J-C�.........Distance to nearest lot line----lQ_---__ Number of pits---4-------.----_.Lining materialC�__ ,_-?,_;7_ 'e Diameter__, _-___--.-Depth_-..- '------------- - Cesspool: Distance from nearest well-------------- Distance from foundation-..-................Lining material------------------------------._---_- ❑ Size: Diameter--------------------------------------Depth------•-------------------------- ----_--:---,Liquid Capacity------------------------------gals Privy: Distance from nearest well------------------------------------------------Distance from nearest building----------------- ---------------------- L1 .--.__---.-_.-- _-_____________.____.❑ Distance to nearest lot {ine---------------- ---------------------------------------------------------------------------------- --- Remodeling and/or repairing (describe):...__ _:"___ ��------�f 1-��1�/_� e-_�,_____ ._ _• --•�-___.---- t��_ f- J----� ---------- ------- - -- -- - _----------------------------------------------------------- .-------------------- -•-- hereby certify that I have prepared this application and fhaf the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. f x E X ( i9 )----------------- � � � � �� • � =��----------------- - t ( ,Contractor) BY: - ---------------------------- Titleve � y` "` 4 (Plot pian, showing size of lot,�cai�onf system in relation to wells, buildings, etc., can be placed on reverse si6el. FOR DEPARTMENT USE ONLY { APPLICATION ACCEPTED BY------------- - , ----------------- DATE-------- Cf --------------------------•--------------- REVIEWED BY---------------------- -------------- ----._ DATE-------------- ---------------PERMIT ISSUED------------- DATE----- ----- �, Alterations and/or recommendations ------ � ----- ---------------------------------------------- ---------•------•-�. ----•------------- -• ---------------------•------ ._ Sf 4 -------- �.--- a -------------------------------------- --------------------------•---------------------------------•----- FINAL INSPECTION BY:--------�-- - -------------------------------------------- - Date...... ------------- v SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street i 300 West Oak Street, 132 Sycamore Street' n. 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California 145446 ATWUuu y'-•' �-��., '�.- 'ham