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-.,PPLICATiON FOR SANITATION I MIT Permit No. ._G:�.�-��• (Complete in Duplicate) iI Date Issued ____�-r7 ---__- Application is hereby made to the San Joaquin Local Health District for a permit to con�st�u2 an�installwork herein scribed. This application is made in compliance._with_County OrWmae No. 549. JOB ADDRESS ANDe QCA o - �- . 0 T11D ---- i -- _. Owner's Name --- -• --•-- - - _ --------------- ------------ ----- Phone------ :------------------------- Address.. eJ (-- ------ Contractor's Name_________ -------------------------- Phone. y Installation will serve: Residence ❑ Apartm t House ❑ Commercial Trailer Court ❑ Motel ❑ Other Number of living units:;_-: Number of bedrooms ____,..-Number of baths Lot size __, ' Water Supply: Public system,.❑ Community system ❑ Private Depth to Water Table ?_` t. _ Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay Previous Application Made: Yes No;j ❑ Adobe Hardpan ❑ i ❑ a� New Construction; Yes No ❑ ty�- TYPE OF INSTALLATION AND SPECIFICATIONS: r(,.11 (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well-----------------Distance from foundation_--_-______---- - ❑ No. of compartments-- - -------= -Size. Liquid depth, Capacity CapacifiY------------------ Dis osal Field: Distance from nearest well Q I -------Distance from foundation____ _ Distance to nearest lot lin ____- Number ai lines-------__d--------- -------- -Length of each line----- -- ,, Width of trench____- Type of filter material_-�_ ) - - - ----------------- Depth of filter material__---I-- --_----_--Total lengthfr > ------ Seepage Pit: Distance to nearest well___------------------Distance from foundation----------________-.#?istance to nearest lot line__.__-_______-__ ,V ❑ Number of'pits----------------------Lining material------------- ---------Size: Diameter----------------------- Depth------ ---- Cesspool: Distance from nearest well .,��_-Distance from fou afiion-_- _��---• Size: 'I'er - - -_ L Hing material ------ -- -- i — - _-- ------------ Depth _ _ Li_quid Ca ac ii ------------- _q f?_ gats. Privy: Distance from nearest well______----------------------- Distance from nearest building A' Q El Distance to'�nearest lot line-------------------------- ---------------- yQ --------------------------------- Remod ling and or_-repairinT(describe):_____ - - ---- - -- --- �- ,- M^.fi ------------------ �- this hereby cerate laws, at I have` prepared this applic9fion and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules end regulations of the San Joaquin Local Health District. sl (Owner and/or Contractor (Title)----- _ ----------------------------------------------------------------------------------------------------------- Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT•US1=.ONLY _ 0 APPLICATION_ACCEPTED BY--'I R EVI EW ED .BY ' --------------- - ------------------------------------------------------- DATE---------- ----------- ' --- -- -- ----- BUILDING PERMIT ISSUED.-------" _ DATE-------- --- DATE -`' Alterations and/or recommendations:-________ ---------- ----- r ------ ----------------------•------------------• ------•------ - ---------J --------- ------- - -------- --- -- X----- Q. -- ---------------------------------------------------------------------------------- ------ ------- ------------------ - ,FINAL INSPECTION_ BY:,. - Date. ------------------------ ° 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 Manteee, California Tracy, California ES--4-2M 10-52 Revised W-2100