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APPLICATION FOR SANITATIO OERMIT Permit No. _-- (Complete in Duplicate) Date Issued --- 2-12- - r� Applica4ion is hereby made to the San Joaquin Local Health District for a Z{2--��U —03 q permit to construct and install the work herein described. This application.is made in'cbmpliarice ith'County Ordinance No. 549. f 3 3 a s°. C-o Z_/ c— f-,E cry •� JOB ADDRESS AND LOCATIDN__:._ -_.. ..____ - � , Owner's Name----------��.f�Z�--- _ . , -- �- ----=----m - - -- -�•-----•----•--- ------------------------------------------------------ ----------- Phone------------------•-------- Address----------- i ••-•-••X----------- -------- --- ;------------•--------------.---•••---------;------ ------------------------------- Contractor's Name---------------- Phone ( Installation will serve: Residence ❑ Apartment House ❑ Commercial A�railer Court ❑ 'Motel Other ❑ Number of living units: _7-77-7-Number of bedrooms 7== Number of baths .-^- Lot size y� CC Water Supply: Public system ❑ Community system ❑ ,:.Private Fq,_D*epth to Water Table__ ft. Character of soil to a depth of 3 feet: .Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay [:1 Adobe Hardpan ElPrevious Application Made: Yes ❑ No A' New Construction: Yes E] No 6— TYPE OF INSTALLATION AND-SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) / 6 Septic Tad: - Distance from nearest well._Ip ___-Distan a from foundation_- ' 9 � Ir -� No. compartments:- - ------_-.-----r.Size�^fk___+�- _____------ �uid dept-----�.-�-----------Capacity.._�.�Qe.__-• i a Disposal Field: Distance from neares welt... a2_ -___Distance from foundation_._ _ .___._-Distance to nearest to Line__ ._____ Number of lines ----------------- -Length of each line--- --------__.Width of french.-_ Type of filter material-/ - --- ---------Depth of filter material----. - Total length---- N �# Seepage Pit: Distance to nearest well---------------------Distance from foundation------------------- Distance to nearest lot line__--_-_____--__ W l ❑ Number of pits--:.------------------Lining material-----------------------Size: Diameter-------------- ---------Depth--------------------------------- Cesspool: ------------- --------Cesspool: Distance from nearest well........ ......Distance from foundation--------------------Lining.material---------------.---------- ----------- y, _. ,._❑ Size: Diameter------ -------------------- _i-------Depth---------------------------------------------------Li uid�Ca acit -- Privy: Distance from nearest well._-----------------------------------------------Distance from nearest building -------------------•-- Q ❑ Distance to nearest lot line.. Remodeling and/or repairing (describe):--------- -------------------------------•---------_--------•-------------•-----•------•-•-- I ---------••----------------------------------------••--------- -------------------------------------------------------- - 1 -------------- --------------•------------•--•------------------------------------------------------------------•---------•----------•---•-----------------•-•--------•------------------------------------------------------ cation and that the work will be done in accordance with Sa - --------- •---------------•- --------------------------------------------- -----• ----------------------------------------•-------------•------------------------------ --------------------------------- I hereby certify that I have prepared this appliJoaquin oaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed)-••• -=- ---- -- �'`�'�.��-----------------------=--------{�wCon+rector) 1� By:. -- --- -- - - -----------(Title{-----` (Plot plan, 'showing size of lot ocation of system in relation to wells, buildings, etc., can be placed on reverse s . FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------------------------- --- ---- ---------------- ---------------- DATE_ --------------- REVIEWED BY--------------------------- -------- ---- ------------ -- - - - - DATE----- ------ p- BUILDING PERMIT ISSUED---------------------------------------------- --------------------------- -------------. DATE------------- ----------------------------------------- Alterations and/or recommendations:---------------------- ---------------------------------------------------------- --- -------•---------------------------------------------------------- --- -----------------------------------------------I------ ------------------------------------------•-------- --------- ----- ------ FINAL INSPECTION BY: -----•-------•-------------------------------- Date SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 914 North "C" Street Stockton, California Lodi, California Manteca, California Tracy. California E5-9-2M 141146 AT11C1