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3 �'A LIGATION FOR .SANITATION PERMIT Permit No. ___✓`� -- .�"�' ,• d (Corrsplete in Duplicate) . `%. / `% Date Issued -------7--5 ------- ' Applicaa-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 Ord AT q &Y 707 pw * f JOB ADDRESS AND LOCATION `=--------------------------------------------------------- --------- Owner's Name--------------•--- _C4 t - Phone Address----------••------------------------•-------------- ------------ ------------------ s-------- ' ------------------- Contractor's Name----------------------_------ :)6 e-,.C......------..W --- 4_a--------------------------------- Phone--------------------------------- Installation will serve: Residence partment House ❑ Commercial ❑ Trailer Court ❑ Mote! ❑ Other ❑ Number of living units: . Number of bedrooms �3__ Number of baths _r_____ Lot size -------- k -------- --------- Water Supply: Public system ❑ Community'system ❑ Private-.��epth-to''Water Table ________ ft. t Character of soil to a depth of 3 feet: d ❑ Gravel ❑ Sandy Loam ❑ Clay"Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yese No ❑ New Construction: Yes No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet. r r Septic Tank: Distance from nearest weh__Z__b._____Distance from foundatiorv_,_� ___-_J____.MateriaL_____ ,,-gg_ No. of compartments............'S�Size__# 1111 .Liquid depth__________- _ apacity_____ 4 Disposal Field: Distance from nearest well._ _ -------Distance from foundation___ d_ rk_.vistance to nearest lot ling?- -f— ,- _ d ; Number of lines_________________ _ __ _ Length of each line___ __. _...Width of trench________ _ r j r Type, or filter: material:_ ,r�_ __,Depth of filter material____._, -_- - _!____Total length___________P:_. __________.-____ R n -. .._. Seepage Pit: Distance to nearest `well" _'_`=.________Distance from foundation______"._____..Distance to nearest lot line_________________ ❑ Number of pits----------------------Lining material------------------ ---.Size: Diameter_�-------------:----Depth--------------.------------__---- ,.. r0 Cesspool: Distance from nearest well-----------------Distance from foundation--------------- ,_.Lining material-------------------------------------- to ❑ Size: Diameter-- -----------------------------------Depth--------------------------- ------ Liquid Capacity-------------------------�_gals. •`4"` -Distance from nearebuildin Privy: , Distance from nearest v✓ell---------------------'----�------------------- �. t _.r ...� 9 -------- ---------------------- ' --- - ---� `1 ❑1 Distance to nearest lot line---- ---•----------- 4 -- - - } ----------+------------------------------_------- •-----1-•-------------------------- -;,._... Remodeling and/or repairing (describe):-------------------------------------------------------- i----------l - = -------------------------- -------------------------------•---------------------------- ------------------------------ . , I hereby certify that I have prepared this application and that the work will-be done in accordance with San Joaquin County t q ordinances, State laws,-and rules and regulations of the San Joaquin Local Health District. (Signed).._.. -------------------(Owner and/or Contractor) Y. •. ------ . fav-- - ---------------•-------{Title '-------=----------_•--•------------------------------------ (Plot plan, showing size.of lot, location 5f system in relation to wells, buildings, etc.,,can be placed on reverse side. i FOR DEPARTMENT USE ONLY 5ilrAPPLICATION ACCEPTED BY------------------------------ -- ------l- ------ :----------------- ----- DATE------- = '------------ REVIEWEDBY---------------------------------------------..-------------------------------- - --- ------ DATE-----------•------------------------------------------------ BUILDINGPERMIT ISSUED----------------------------•--------- -----------------•----------•----=-------- DATE----- -----------: Alterations and/or recommendations______________________ ______ 1 --------� a -----��' I----------------------------------------- ----------------------------------------.---------------------------------------------------------------------------- - -------------------------------------------------------------- ----- ------------------------------ l .. --------------------- ------------------------------------------------------------- -------------------------------------------------------------- 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-4-2M ; Revised W-2100