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APPLICATION,-,FORiSANITATION °PERMIT Permit No. .g...... f�.?..: (Completrin Duplicate) .. Wa, Date Issued -- --- G •r '- Application 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 rdina6ce No. 549. fti � - JOB ADDRESS AN LOCATION____ ------------------------ }. ------=------ Owner's Name----- t/ --._:.---[=:------t----- ......-......` -------- ------ Phone--------------------'..---------•--- Address -- :- ==.....__• --fit -- --------- 00, Contractor's Name --------- Phone.----------•-••--•---------------- � , "�" "� I t. Installation will serve: 'Residence O"'OreApartment House❑`` Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: '-,-/____fNumber of bedrooms_-1--__Number of baths __ ___ Lot size --�, --------------------- Water Supply: Public.system V Community system []r Private ❑ Depth to Water'Table ------- ft. Character of soil to a depth of 3 feet: Sand,❑ Gravel E] Sandy Loam ®*Clay Loam F-1Clay E] Adobe EZ;,.rHardpan F] Previous Application Made: Yes ❑ No R1 New Construction: Yes ®.0,0,;No ❑ FHA/VA: Y ❑l No p-'O* TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted ifxpublic se er is available within 200 feet.) ,,r D'1starjpT fro, fo dation Material __< Septic Tank: Not of com artmentsr_well'- p rSize '..�'_ ---Liquidddepth--.--- .-_ --�----------Capacity--•*-.--- -- f f �� Disposal�l=field: Distance from nearest well__ __�_�istance from foundat_ion__; _ _ _-Ristarica to nearest Iot�lin�4�. ►�� +® Number of lines___--___ __ ______.._ _Lengthrof each line----_-__11' .',__.Width of trench-__'--- -------------------- s * Type of filter materi 1 .' Depth of filter material________ __ _______Totay length....... _ - __....__...___..._,. Seepage Pit: Distance to nearest well---------------------Distance from foundation---.................Distance to nearest lot line-----.-.-----_.-- , [� Number of pits----------------------Lining material------------------------Size: Diameter-----------1----------Depth------ ------ Cess`pool: Distance from nearest well-----------------Distance from foundation------------------ -Lin)g material----,--------------.--..___---__.-._. y Size: Diameter---- =------- ----------------------De th----------------------------------------------------Liquid Capacity --gals. Privy: Distance from nearest well------------------ .____-__-_-__Distance from neares building------------------------------------------- ClDistance to nearest lonline------------------------ --------- -'------ -------------------------•--------- '- -------------------------------------------•----------- 4m�odeling an or repairing (describe):-A----------------- ----------------- ..............-_.-------.------- ---------------------------------------------------------------------- -..---------•-------------------------------------- - �" -------------------- i I hereby certify than I ave prepared this application and that the work will be done in accordance with San Joaquin County ordinances, X0e laws, a rules` d regul7itins of the San Joaquin Local Health District. f�f ; (Signed)_.._,, --r---- ------- -�-.------��'-�`=d-'--- __---- ----------- --------------------------------------- -(Owner and/or Contractor) 1.1 y k- Ij By:----------------------------------------------------------------------------------------------------------------------------------(Title)-------------------------------------•-------------------------- •(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 BY9-------�----------- ----- --------------------------•-•------------------------------------ DATEU---------------------------••----•----------------- REVIEWEDBY-------------------•--------k'"-�-I--------------------------- ------ DATE _U ---•----------------------------------------------- BUILDINGPERMIT ISSUED------------------------------------- ---------------------------------------------------------------- DATE------- ,,------------ Alterations and or recommendations-------------------------- ---------- -------------------------------- ---•---.-•----- -----*----------*------------------------ "1- ------------ ._d__""- - ---`1q --------- ---------------- ------ ------------------------------------ __s=- f� a-�----- -t�.�.t c?�.� � ��e.. ----------- fi FINAL INSPECTION...BY:----- ------- ------------ Date - -------------------------------- SAN OAQUIN 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 1.57 F.P.CO.