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APPLICATION- FOR-,SANITATION- PERMIT T' Permit No. .------5- ._... (Complete in Duplicate) Ii Date IssuedA_1` i. Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work here- described. This application is made in compliance with County Ordinance No. 549, JOB ADDRESS AND LOICATION------ M^'- - - -----------lftw ---------------- Owner's _ caner s Name _ _ Phone . Address_..- �q � f£ � �,.. Contractor's Name-- -- ---- -- ------- = Phone. Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑� Motel ❑ Other ❑ Number of living units: ___/___ Number of bedrooms _ _. Number of baths Lot size __/_,Z__a--- -1 Water Supply: Public system"❑""Commuriit.y�system'2111"Privafe'0epth;t! Water Table tk--_ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam C a Loam ❑ Clay ❑ Adobe%Hardpan [] Previous Application Made: Yes ❑ No [j" New Construction: Yes. No ❑ PHA/VA: Yes'❑ No ® r =1W TYPE OF INSTALLATION AND SPECIFICATIONS: r /� (No septic tank or`cesspool permitted i li ewer is available i+ in 200 fe9t.) t Septic ank: Distance from nearest wel!__- _ .- past 1!r ro rr � on�!!_ _________Ma e�ial-- .D - No. of compartments_.________ . _______ ___Siz --- ------ iquid�dela ------ Capacit �_t�_�P_0 Dispos I Field: Distance from nearest well .)_._`.,_Distance from foundafiaP.�6�7Distance to nearest lot line__- Yom- ' Number of lines___________` ` ' o ��. _„SI -Width of french.- ------- - � f - '- - -------:Length of each line---- - - - - - - - -f-- --�------------ Type of filter mater;$_ _.;,A..�h��-Depth of filter mate rial-_ _��_�i�i_____Totaf 'length.______----,✓�_�________________ oundation___.__:__---3__-___.Distance to nearest lot line____._______.._ See�ge Pit: Number of p is rest well__-----=-..ining mDateraalce from-f-}------Size: ---.Size: Diameter---------�---:" d I ------.Depth---------- Cesspool:-. Distance from nearest,.well-----------------Distance from foundation-'_..._____-_____.Lining material------------------------------- ___._.. O ❑ Size: Diameter-------- --:- __! Depth --'--- -- }-------- Liquid Capacity gals. Y ,.. � - ---Distance from -eeare+st b0clinng--- ----- ---•------------------- Priv Distance from nearest well___ ----------------------- _____. __ _.. . ❑ Distance to nearest lot line..- -=-`--=---------------==----=='-"------------==-----.-.....-.-------------------r------------------------------------------------- R mod 'ng a d/or repair g (clescribe)c_ _/I "' ------------------------- n----------•--- ' -------- / -------•----------------------------------------'---=----•--------•---- --------------------'i--- -- I hereby certify that 1 have prepared this application and that the work will be done in accordance with-San Joaquin County " ordinances, State laws, and rules andiregulations of the San Joaquin Local Health District. (Signed - --- -------------------` ---•.----_-------_{Owner and/or Contractor) ----- _ , -, Tale = - ----------=----- r --------- --- - (Plot plan, showing size of lof, location'of system in relation to wells,'buildings, a+c., can be-placed on reverse side). r r FOR DEPARTMENT USE ONLY ' APPLICATION ACCEPTED BY. -- ------ -- --------------------------------------- DATE REVIEWBY__ --------------- --�=-- ------------------ ---- ----------- --- ---------------------- =------------ 'a DATE.� = BUILDING PERMIT ISSUED ---------------------- � + r------ ---------- DATE ---------------------------------------------- Alterations and/or recommendations:-------------- �� ------ tf$ --- --- ---------------- - --- -----•-------------------------------- --------•--- 4' ,, - 1a --- ----;------------------------------------------------------- - 40 -------------------- ------ ----..------------ ----------------- -------=-- -------�--------- ------------- - _ T a-dl4 FINAL INSPECTION' BY:-------- -------------I------- --- 1 ------------ Date--------------------- $� li SAN JOAQUIN LOCAL HEALTH DISTRICT .i 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 : Revisea 1.57 F.P.CO.