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A �dAPPLIC T N - R SANITATION PERMIT Permit No. .__J1 Complete in Duplicate) Date Issued __7_. S • Applica ion is here y made to the S Aoaquin Local Health District for a permit to construct and install the work herein This application is made in complianc�'e with County Ordinance No. 549. a sn described. JOB ADDRESS AND-L CATION-----9S7_7_ - , - f 7- *Si l � X Owner's Name---- lar v-�---------- _ --- ---`-------- Phone -------- Address -r-6-Q---------- _AyvlM......S�.--------�_TQC1��.__ . �/ ------ •--------------- Contractor's Name •-------•---- •---------------------------------------- Phone#----- Installation will serve: Residence ❑ Apartment House ❑ Commercial 9 Trailer Court ❑ Motel [❑ Other ❑ .Number of living units: _f-_-____ Number of bedrooms ___.____ Number.of baths -L_.-_ Lot size ----ZO-0 �--�-{ 411 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 [9 Hardpan ❑ r Previous Application Made: Yes ❑ No % New Construction: Yes No ,[:] TYPE OF INSTALLATION AND SPECIFICATIONS: ' (No septic tank.or cesspool permitted if public sewer is available within 200 feet. ,I Septic Tank: Distance from nearest well_I 9* -Distance from foundation_-__. - -----------Materia#----- � ----- - - ---=- No. of compartments.- " � s p -------- ..depth---`-S-Z--- ----------- Disposal Field: Distance from nearest well------------------Distance from foundation_______-_______.-_.Distance to nearest lot line----------------- El Number of lines------------------------------------Length of each line----------------------------_-Width of %j ------ %j F ____•_ Type or filter material:_______________________Depth of filter material-----------------------Total, length____.______-______--___________-.__.__ Seepage Pit. Distance to nearest well_ ��/ fJJ ___Distance from foundation_ -.__._._..Distance to nearest lot line_-L_ya_______ Number of pits.rtif_�A-.-------Linirt material__4R9k_4-1<_-Size: Diameter_,33--............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 ❑ Distance to nearest lot line_____---______________.___ � . Remodeling and/or repairing ---------�-----•- 1 -� --------------•- i - ------------------------------------------------. ' ._ - - _RE-4--------0-V -------------457 7_f. l� -------�,0------------ E' -------- _VZr 7(------0-9_ ..'S I --jq C° -` -------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State la s. and rules and regulations of the San Joaquin Local Health District. l (Signed)------------- ---.1911. 19 C_._ _-Ay. 1 "A e,, ---------�1' ----- - and/or Contractor) - Owner By: ll�!1/I� � ( ! ------ --- ---- _- .---------(Title)-------F7 .:5 _ ------ ot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). + FOR DEPARTMENT USE ONLY p.. APPLICATION ACCEPTED BY I------------------------- DATE �F -------------------------------------- REVIEWED BY ------------------------------------------- ------ DATE I ---------------------- -------------------------------------- 5 _____________.___--_____.._____._ DIN PERMIT ISSUED. --=--•------------------ --------=----------------- ---------------------- ------ DATE Alterations and/or recommendations:_l_______________ .I -------•---------•---------------------------------•----------------------------------------------- --- ----- --------------------------------------------• --- ---------- --------- ----------------------------------------------- --------- -------•------------------------------- -----•--- - - - - -------------•-------- --- ------ A --- FINAL INSPECTION BY--------------- . = Date 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 ; Revised W-2100