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b APPLlCATIONQR;SANITATION PERMIT Permit No. .... S.. S 11 _ (Comple a irr Duplicate) • �w � Date Issued Application is hereby made to the San"Joaquin Local Health District for a permit to construct and install the work herein described. This applicafiori is ma e in cZ10 liance if Co linty Ordinance No. 549. JOB ADDRESS A 6 VOC� N _ - -- - -- ------------- ° ' N_ `" ----------•---•-- Owner's Name---- - --•- ' - ---------=--------••-------------------------- ------- Ph`one. y ----------------- Address---------- ---- - -------- ---------------••---------...................... Contractor's Name-- ---------- -= �G x ---------------- Phone----------------------------------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motels❑ Other E] } Number of living units: ___/___ Number of bedrooms _3r-Number of baths _ _ Lot size ___ _ .__ --_!_..L!.t, -- ___-_.--.-• Water Supply: Public system ❑"rCorinmun'ityisystem[`Private❑�"D pth"to Wate Table'i" __ ft. Character of soil to a depth of 3 feet: .Sand ❑ Gravel .❑ Sandy LoamoP Clay Loam ElClay ElAdobe f Hardpan ElPrevious Application Made: Yes E] No LTJ New Construction: Yes Alo ❑ FHA/VA: Yes ❑ 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" Dist n e fro f undation__.____ A-..- �- rP P '� Ma.t�rialr_. ' 7'//r i I r [V :No, of co pertments__.___,.,_., ________%Siz _ � _S--- Liquid tdepth._._:__- ?..............Capacity.."`__._.__'_- Dispos Field: Distance from nearest well __.______.. .Distance from foundation)6--_.u_f+��..].Qistance to nearest lot Number of:lines_____!__ `�,_ ___________ _ Length of each line��_P_'-'� '"+-4f.Width of french.___.______.+ r Type of filter materi�'at►Y t�. '"Depth of filter material___ _ 1 Total length------------ --______�___. [+ , � m� - � a �See a Pit Distance toneartll IDistnto nearest let line `_.__.._ Depth____ Linin9 material_-_ Diameter.__-_* ' Cesspool: 'Distance from nearest well______ Distance from foundation"'""""'"" --- Lining material-__ _ ____________________ _ "" Size: Diameter___ --- .Ds` th__ - ? ' _ " Li lid Capacity els. ❑ P - ----- -- - � ,q p y--•--------- ------- ---- 9 r , Privy: Distance from nearest well-------------------------------_ _._____'--___Distance from nearest building________.____________-_- ____-._____. ❑ Distance to nearest lot lire---------------- -----------------!,,.,: = •-�''t --- f�emo41ril...- d/or r airing de _rib ) ----- -- -- - �/ �f ---------- a---- ------ --- --------- HI _ - ----------------------------------- � „�_ . t I hereby certify that I have,prepared this application and:A t,+he work.w.ill be done in accordance with San Joaquin County , ordinances, State laws, and;rules.and regulations of fhe'San-Joaquin'Local Health Distric+;*+ ` d `t.Tl {Si 9ne )-----•-- -------------.---------`-•----------` -------------------- ----=----------- ----------'-�------------ ---------- ---- - ------------------(Owner and/or Contractor) ' By:--------------------'----------------- ------------------------------------------------------ -------------------�------------------ (Title} ------------------------------------------'---------------- (Plot plan, showing size of lot, location of system in relation to wells;4buildincgs, etc., can be placed on reverse side)., FOR DEPARTMENT USE ONLY i APPLICATION ACCEPTED BYDATE' - -••--•----------------------•---------•------ REVIEWED BY-------•------------------- DATE__- .:. BUILDING PERMIT ISSUED= ---------------------------------------------=--------------------------- DATE ----•-------------------------- ----------------- Alterations and/or recommendations:---------- ------- ------ ------- --------------------------------------------------------------------••------•-•-----------•-•--=-----------------•----=---- FINAL INSPI CTIONBY:. :. `----------------- . ,:! Date I ------'- -, ------------- ' 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 J ES-9-2M Revisep 1-57 F.P.CO. i 'i