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_� Ili -�,.. ! a- 3/ -SaZ a_"a�ZA�PPLICATINFOR SANITATION PERMIT Permit o. ___.__�_g..�-___ (Complete in Duplicate) pate Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described_ I This application is made in compliance with County Ordinance No. 549. of~C�� b' —N`iCZGtJ ------------- JOB ADDRESS AND LOCATION--------------------- -----_9--- - Owner's Name--------------------------------- ---------- �" Phone =:_]. _ _ - Address------•------------------------------------------------ �_ , 0, ,= Contractor's Name-:----------------- Phone �t l`�' Installation will serve: ResidenceX Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __L_--Number of bedrooms __/___ Number of baths __- Lot size --------_______f------------------------ Water _____________--------Water Supply: Public system $ Community system 0 Private jg�Depth to Water Table 4"-U ft. i Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe IK Hardpan ❑ Previous Application Made: Yes ❑ No DK New Construction: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) T Taii:- Distance from nearest well-----------------Distance from foundation. ___________Material____________--________________.. s --_____________. � No. of compartments -- Size_ Liquid depth Capacity Q ------- Disposal Field: Distance from nearest welt__-____..Distance from foundation.__.�a__________Distance to nearest lot line____�f _ •Number of lines-------------I---------------------Length of each line------------- --------Width of trench--- `?�= Type of filter material__.5.-___P_ •�,.�p ��.-'--��`�-�---,Dista e o nearest lot line----------------- Distance r jl -----De th filter I I&-----------Total length----------------- Seepage Pit: to nearest -------Distance fr fou ation_______.. �� b Q Number of pits________-/-----------Lining material_CC._f -Size: Diameter---3_S�-------------Depth___ ________---_----- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material-------------------------------------- El ____________- ______--_________-_.❑ Size: Diameter---• ---------------------------------Depth---------------------------•------------- ---------Liquid Capacity----------------------------gals. ` ----------- ------Distance from nearest building_-__ ------------------------------------ Privy: Distance from nearest well------------------------------- ❑ Distance to nearest lot line----------------------------------------------------------------------------------------------------•---------------------------------------- ! e Remodeling and/or repairing (describe) 1'�1 L' t _ 5.� r''„ L ------ - _______________________•_______.._____-_•_______--______-_____--._______-_________.-________________-----_______________-______________________..--_________--_________.--__--__ 5 4 --------------------------_-----------------------------------------------------------------_______________________________________________________________________________________________________________________ I hereby certif at I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State , and rules an regulations of the San Joaquin Local Health District. ------------------------------------------------------ (Signed)____-__ ___ (e and/or Contractor) ------- --- -- ----------------------------------------- - ------------------------- By= -- - - ---------------(Title)------ [Plot plan, showin ize of lot, iocatio of system in relation to wells, buildings, etc., can be placed on reverse side]. FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY------------------------- ---------- --- ---------------------------------------- DATE-=----------------t Q; 7.;5= ------ REVIEWED BY------------------------ - -- - -------------------------------------------------------- DATE -- --------------------- BUILDINGPERMIT ISSUED-------------------------- --- ------------------------------------- DATE_----------------------------------------------------------- Alterations and/or re o mendations:---.----- ------------ ----------------- --------- ---------------------------------------------- _ __- ___ _ _ _ _ _____---_________-___________________________________________________ __ ___________________ _ -----______--_______--- ___ _may�_�___� I_Y y�4M 4�- - __ _ e ------------------------------------------------------- 10 -------- -- -4`'" 8�""�(-----R- ------------------ --- -- - ` ---- --------------- Q 'a QQ `' `,�'`-� ``G�`r -------- ---------- --�k� - FIN L `INSPECTION Y Y: _ Date---- FIN ---{---_t- ----------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 youth American Street 300 West Oak Street 132 Sycamore Street 8.14 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M 8-51 Revised W-2100