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F ' ..3 , APPLICATION 1=OR ANITATION PERMIT Permit No. ......... ..... (Complete in Duplicate) 'Date Issued ------------�---r°-- pp lica}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 Count Ordinance No. 549. ' JOB ADDRESS'AVD LOCATION-_.4 AA .. 5,..� 7Owner's Name ----- - �`Y!s ? '�.� - Phone. .- - - -- -Address------------- -•---• ------------------------------------------------------------.........................--------------------•---.-..---------------------------------------- ----------------------- �. Contractor's Name..-A----- ---- - -- - ---------• --------------•------------------•--, ----------------- •------------------ Phone.j/J_ -3--3- S Installation will serve: 'Residence Apartment House ❑ Commercial ❑ Trailer :Court ❑ hdofel. ❑ Other ❑ _ Number of living units: __�.____ umber of bedrooms Z'__ Number of baths ___).,. Lot size .. -___ ----�_14t�_______-.-#___________________ Water Supply: Public sys#errs Community system"[] Private ❑ Deiofh�'#o Wafer Table ft. ` Character of soil to a depth of 3 feet: .SandGravel E] Sandy Loam Q Clay Loam ❑ Clay ❑ Adobe Hardpan E]Previous Application Made: Yes.❑ No New Construction: Yes No ❑ s TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic,tank or cesspool permitted if public sewer is available within 200 feet.) # septic T k: TMDistance from nearest well___Y_______ Distance from foundation--------------------Material--------------------------_-_------_--________-_. No. of compartments--------------- -.-.Size---"---------•---------------Liquid depth---------------------------Capacity----------------------- Disposal Fiel : Distance from nearest well....... .....:Distance from foundation---------------____.Distance to nearest lot line_______________._ Number'of-lines----.-._'--- -------------•-----Length of each line-------------------------------Width of french---------------------- Type of--Filter mater_ial---------------------- -----Depth of filter material--_-.-------------------Total length------------------------- f .-..----.------.-----------.---j.--.- p g - - mac o nearest Eof line -JQ__-•-_-• \ Seep Pit* Distance to welts '_ ._-Distant frQrn foundation3 ______.....�Distan � �epth_____:t lin__e----.-_______ V) Dumber of its---— ---------------Liningmaterial__ ______.___ __ . -.Size: Diameters -,��+�j R �*�1oR.� $�. Cesspool: Distance from nearest well---':-:----------Distance"from foundation--------------------- material________._____.____._________________- I 1 Li Liquid Capacity---------•------------------gals. �] Size: Diameter :_ Depth = = a Privy: Distance from nearestwell----._.._'_______________________________.___,__Distance from nearest building_;_____-___._______-____ ❑ Distance`to nearest lot'line= ------------------------------ .. Remodeling--a--n--d--/--o- nd/or repairing (describe:_. :4 � ' ' ------------- ---------- -----------------------------------....-------------------------------------------------------------------------------- ----------------------------- -----------------•------------------_-----•-------.----------•------------------------------------.---__-_-.--------•-------------..---------------------------------------••---------------- I hereby certify that h have prepared.+his application and that the work will be done in accordance with San-Joaquin County ordinances State laws, and Fules and regulations of the San"Joaquin Local Health District. t (Signed ------ 1�- � ---- = - �------- ------ ------: ------#--------- --_------- and/or Contractor) __ : ner' ` .l t -------------------- - - (Title. ` (Plot plan. showing size of to location of system in relation to wells; buildings, etc., can be placed on reverse sid� FOR DEPARTMENT USE ONLY APPLICATION ACCEPTE=D BY -------------------------------------------------------------------------------------------- DATE-- _ �--------------------------------------------- -- REVIE=WEb BY--------------------------------P -----(N-----------------------------------------------------------------------------_ DATE---- `-------•--•---------------------------------------- BUILDING,PERMIT ISSUED---------- --------------------------------------------------------------------------------- DATE-----• Alterations and/or recommendations:----------------------------------------------- -----------------------------------------------`-----------if -•--------------------------------------------- --------------------------------- ------- - ---------------- - -- -------- -- ------ __________________________________ -\___. __-. ...._.___-_______--_-______._-__-.-._----___________f�__._.._....------•---.______________.._............. . ________......__....___.......__........._._.... ------------------------------------------------------------ k ------------------------------------------- ------ ----------•-- ---------------------------------.—...__...__ FINAL INSPECTION BY: _� ,( .1— --------------------- _ -_ -t •- fie I - _�_ ------------- Da 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