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_ APPLICATION FOR SANITATION PERMIT Permit No. .......6O.-S_.Z'_- (Complete in Duplicate) m ... Date IssuedS t` ----- --------- 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 made in compliance with County Ordinance No. 549. . _ _ ..__ - / JOS ADDRESS AND LOCATION...___ __ } D - --------- �- --••-----------------•--- ---------------- Owner's Name------_J__P 5:�- °A- _ --------------------;.- -- ------- -------- ---------------- _ - -------- Phone Address............ �.. Contractor's Name..---- v --- ---------i-�----I-•-$•----!-�----•- r ----------'---------r•--------------- --------•--- Phone----•------••------- � Installation will serve: Residence ,�`A artment House Commercial ❑ • L� P ❑ ❑ Trailer?Court ❑ Motel [] Other Number of living units: __ _._ Number of bedrooms ...2—__ Number of baths Lot size _Z5 ___-X_ Water Supply: Public system Community system ❑ -Private ❑ Depth to Water Table 0-0_ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel [] Sandy Loam.[] Clay Loam ❑. Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑ No [ New Construction: Yes p_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_!,Q&' `Distance from foundation____f_6 No. of compartments.. ----Av- -------------Size-----••----•-- Liquid depth-----6 --------- Capacity_._5;�0_0--------- Disposal Field: Distance from nearest well_A✓_"f_-Distance from foundation-_.f-F.:!�?-------Distance to nearest lot line--- ------------------ --------- - Ca_ Number of lines------ / Length of each line--------.3�- -:--- --------Width of trench.._...?--------------- �� Type of filter material-_ ._._2-_S_ '_Depth of filter material_-__./e _ ----Total length--------6-a_-_-__ See a e it: Distance to nearest w/�IL/4�o'� _-Distance from foundation-____ -_Distance to nearest lot line-___r.a__f. Number of pits.--_--__./-_-._..__Lining material-_�_►_ -_ -Size: Diameter-- r --_----Depth-_---- ? S g' r 3 Cesspool: Distance from nearest well-----------------Distance from foundation........_'...-____._.Lining material__.__._.___-_.-..._..___.______.-____. ❑ Size: Diameter--------------------------- -_--Depth-------------------------------- - ---------- }-Liquid Capacity--. == -----------gals. A. Privy: Distance from nearest well------_-----_------------------- - --------- from nearest building Distance to nearest lot fine J s Remodeling and/or repairing (describe�:__._... -__---------�•�,S_-! 2-------- -----•-------------- •---------------•-----•--------------•-------•---• .j - • -----------------•------------------•------------•-------------------•--•---------------------•----------------------------------•--------•---------. ---------------------•---- -----•-------•------•---------------- ------------•--------------------------------- --••--------'------------- ----------------------------------------------- ------------I-------------- ------------------•--------------------'-- -------•------------•-•------------------•-- ! hereby certify` that I have prepared phis application and that the work will be done in accordance with San Joaquin County ordinances, St Wlayvs, and rules and regulations of the San Joaquin Local Health District." ; (Signed}:--:--- ------��,�� /,� ��,r,/C ' . -----� - y_ Owner and/or Contractor] By�----------->' 1-, / .a , --------------------------------------- ----------- -----------------•------------------ ride L 1 9 (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-------- ------ -------------------------- -------------------------------- ------------- DATE__--------------------------------------------- REVIEWED AT __------------------------ REVIEWED BY '-------------- -----------------._:------------------------------------------------. DATE' BUILDING PERMIT ISSUED---------------------------------- _----------- - DATE.-`------------ �' Alterations and/or recommendations:---------------------------------, -- '" -'-- _ •_._-.. ...-. ----------------••----------•-------•-- •----------------------- --------------- ------------ --------- ' __- ------ -------- �......�--- - ---r----�1_ __._ - .__ GNALy� INSPECTION BY:---- - ._. D ► , SAN JOAQUIN LOCAL HEALTH DISTRICT E '30 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California Id5aa6 a'r WOOD