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Permit]No. le-0-------.l 1 APPLICATION FOR SANITATION PERMIT l 5_ (Complete in Duplicated Date Issued ____1------ - ork herein described. Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the w pp compliance with County Ordinance No. 549. This application is made m w { 0)C?- =, ----------- ---------------------- ----- I ---- r ICP _ --- JOB ADDRESS AND LOCATION_._--------- ------- --- ---- - �r _�_: { _�_ M----__:------ 0.- - ----------------------------- Owner's Name______________ _ - ------------------------------- Address----------------)-a--7------•- --� --------�--•--- Phone---...--•---•---------------------- Contractor's Name---- -------------------------- ------------------------- ---- ------- Installation will serve: Residence � Apartment House [I Commercial ❑ Trailer Cour} [I Motel P Other [I Number of living units; _-:t_--_ Number of bedrooms'--2--- Number of baths _..k-__ Lot size ------ ........................... Supply: Public system Community system ❑ Private ❑ Depth to Water Table -------- ft. PP Y: ` Clay [] Adobe Hardpan ❑ Character of soil to a depth of 3 feet: =Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Y ❑ Previous Application Made: '-Yes E] No No New Construction: Yes.. , N.oF}fA/VA:Yes ❑ No P PP A 9 TYPE OF INSTALLATION AND SPECIFICATIONS: 3 (No septic tank or'cesspool permitted if public sewer is available within 200 feet.)" 1 S ptic T nk:.- Distance from nearest well_-.__._________Distance from foundatioq......_.._�.__--.Materia��,______________ ____ •-.---------------`---• Size ---------Liquid de f h------------------ -------Capacity i No. of compartments._-____--.-___--_ r -, �-------.Distance to,rsaresfi lot line.----.T_______ \ Disposal Field: Distance from nearest well_-_ -___-Distance from foundation - Width of trench.._ .__.. Number of lines ---j� - L,.�ength'of each line-------- - e th of filter material-2_ �-------Total length--------- Type --.-- J V Type of filter material.---- J�_ .KZ p Seepage Pit: Distance to nearest well _.E.:nin mDa}eraiel a from- found Ze n�i�me�er-{_Distance to nearest lot line---_---_--.------ ❑ � Number of pits---------------------- g Cesspool: Distance from nearest well__--------------Distance from foundation-7._.----..__..___.Lining material-_-____------------------------els. Dept _ -Liquid Capacity----------------------------g ---------------- --------- --- Size: Diameter------------ -- . > ❑ � Q nDista�nce from nearest building +-S-.-o-S--i-�--]- --�--. ---1--L-.-z-t-----�-,-�-,- --------- --- Privy: Distance from nearest well---------------------- - -------- --------- --- - istance to nearest lot line_------------------------------------------------------------------------- !-- -� - } ------ . Remodeling and/or re air:sng describe� t� �'----- � ------------------------------------------ ------ ----------------------------------- ---p----------------— -------•--- - _---------- -------al ------------------------------------ --- --- - ui - I hereby certify that I have prepared thisapplication the San Joaquin hL cork will be done in accordance with San Joaquin County ordinances, Stat w , and rules and regulations Health District. • I ----------------(Owner and/or Contractorl (Signed) --- ----- I: r . I . _ ------- ----k�---- ----(TYt el-----[------------------ B _ showing size of i- on - --- (Plot plan, sh g lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTS I----. -- DATE ---- ilv D BY--------------------- 1 r , ; DATE----- -- ------------------------------------- :R f., .r # w ----- "�I,,. REVIEWEDBY------------------------------------------------ BUlLDlNG PERMIT {SSU ----------------------------------------------- 4 -------- -------- DATE------------------------------------------------------------- BUILDING - ------------------------------------------ Alterations and/or recommendations------------ ------------------------- ------------------------------------- -------------- ------- -------- FINAL INSPECTION- BY--- ----- ----------------------------- -------- ----------- ----- Date----�- -------------- -�---�- ------- -�--- 4 SAN JOAQUIN LOCAL HEALTH DISTRICT 132 Sycamore Street 814 North "C" Street 130 South American Street 300 West Oak Street Tracy, California Stockton, California Lodi, California Manteca, California ES-9-2M , Revisod 1-57 F.P.CO,