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F APPLICATION FOR SANITATION PERMIT Permit No. .._ _7........ (Complete in Duplicate) Date Issued --- �z, Applica+ion is hereby made to the San Joaquin Local Health District for a permit to construct nd t This application is made in compliance with County Ordinance No. 549. s II the work harem described. JOB ADDRESS AND LOCATION... _Ta_-- -�- ~--•• ------------------------------------- e,�_ Owner's Name......... 11 • �--•--- -- Q--�eJ'1-C�--------/ •I" �L § -----.-- Phone.- ----- + Address--••----•-•--•---• 1.- - 3 ' -4-- ---- -•-k ------•-•--•-----------••-------------•----- ---- Contractor's Name. �1 CA 4X G• ------------------------- Phone - 7Q --- Installation will serve: Residence partment House ❑ /Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __... _ Number of bedrooms ___ Number of baths ._�-___--Lot size __.--- — `` '�!� �-- ---•�----1--�--------------- Water Supply: Public system Community system ❑ Private r] Depth to-Water• Table _�_"+C�ft. " Character of soil to a depth of 3 feet: Sand ❑ Gravel E]._ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑ No ❑ New Construction: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: o septic tank or cesspool permitted if public sewer is available within 200 feet.) ..,. epticDistance from nearest well------------------Distance from foundation--------------------Material _____-._-___.______-_--:.______-_- • - ------------ No.,of compartments-- ---- - --Size....-----------------------.___Liquid-.depth---- --------- Capacity----------------------- Fi Disfaric'e from nearest well ______---_......Distance from foundation_____--:------------Distance to nearest lot line___---__________ E. Number of lines-----------------------------------Length 'of each-line------------------------•----.Width of french 'Type of filter material__________ ______________Depth of filter material-.._.___._`_.......-_Total length___ --------------- --------------------------------- Distance _________ Seepage Distance to nearest well_ ---x_pistanc rom oundatio 1st to nearest li�Q-` _ q. .. Number of pits.--�__.I�i�._.__Lining maferial . - � .i lv Size: Diameter- --------Deptn_ ------------------------ Cesspool: D}stanc from nearest well_________.____-_Distance from foundation._.___ .._ R4 Lining material ----------------- ❑ Size' Diameter------------------- ------- Depth----- ---------------------------------------------Liquid Capacity- gals. Q Privy: 'Distance from nearest well-___...-_- 4___.___. ----._____'_--Distance frorn nearest building Distance to nearest lot line-..._.._____.:._ . Remodeling and/or-repairing (describe)__________________________'_ ' -------------------------•-----------------------f-----•--------•-------•------------------•-------------•----••------.----------- --- ------------------- r �"= ` ------------------------------------------------------------------ --- ------- -- -•-----------•--------••--_--------- = I hereby certify that l have prepared this application and that the work will be done'in accordance with San Joaquin County ordinances, S+ ws, and rule&"� of the San Joaquin ocal Health frit+. Septic Tank Service (Signed) - ;ZA6 So,-Eldoxad¢ NO.2404-6 ----- -- -- -------------- „SKI—- Contractor) By:-------------------------------------- Siockion, Calif, f -•------------------•----------- ------------ ---- f +I sti•S✓a,�,r (Plof plan. showing size of lot, location ----------------- 0 f system in relation to s, buildings, etc., an be placed on reverse side). FOR DEPART ENT USE ONLY APPLICATION ACCEPTED -----------------------B--Y--------------------------- --------------- DATE---------------•--WED BY ------------------ ---- --- x DATE BUILDING PERMIT ISSUED--------- } ------------ DATE Alterations and/or recommendations:-------------'----------------------------------- _ - --- r �y ---------------------- -•.---•----•----•---.-----------••---•--- -'- '. -- ----j---�-- r ------ '_:� ------------------------------------- ____________________________________----__-.______-.__ 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 145446 ATWOO❑ IZ-54