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APPLICATION POR, —ANITATION PERMIT Permit No. -- 23_ 3.- - �'Ys (Complete in Duplicate) Date Issued __ Applica4ion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. �4 JOB ADDRESS AND LO ATION_ n _ ----t-----_ •-•-- ----- ---- y Owner's fir. + -- - -• p 22 2 --------- -•---- ----- Address--- ' .J.� �..- �3 -- a (f ... hone -------------------------/ Contractor's Name-- Sl e�I------------------------ ------------------------------ .--------. .......... Phon40-3-1-3 1C . Installation will serve: Residence VAparfment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _-.�- Number of bedrooms -2.--- Number f baths ----I--- Lot size -------2_-�C/'14 ,) - Wafer Supply:Supply: Public system ❑ Community system ❑ Private Depth to Water Table .'#�3� ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam P Clay Loam ❑ IClay ❑ Adobea/Hardpan ❑ " Previous Application Made: Yes ❑ No fid" New Construction: 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-1500/-------- ..---.-_Distance from f undation---AN( ��_-.Material_(19A 0C��_ No. of compartments..--`L- -/- ------SiZ44-,4'&A---- -W___Ligwd depth -------Capacity--- Disposal ield: Distance from nearest wellan'-----.---Distance from foundatior--AN _--- _---- Distance to nearest lot�jne_��1�-` .__ --- T Number of lines --_-F--_._... -. __ Length of each line-----___0-_---__ Width of trench -. 2- ------------- - --------- - ----------- Type of filter material......... .....� -Depth of filter material-_!-2` ------------ otal._ length---•�(q---------------------------------- See ----•------ - -Seepage Pit: Distance to nearest well.1 -0-E-------_--Distance from ou dation- f �s�C�._-..Dist��ce to nearest lot li e��__ Number of pits___l.______...-___Lining materialA-*-.---- ¢6 -Size: Mamefer--___-3P-------------Depth---2-1 --. !�1 ------------------ Cesspool: Distance from nearest well--------------_-Distance from foundation------------------- Lining material-------------------------------------- El ----_--- _.---.___--.-- _-_ -_- ❑ Size: Diameter------------- ---------------- ------ Depth------ ----------------------- - - -----------------Liquid Capacity- --------------------------gals. Privy: Distance from nearest well -------------_-..------------- e..•. __.....Distance from nearest building ❑ Distance to nearest lot line---------------------- ----------------------•----------------------------- Remodeling and/or repairing (describe):-- a.- ---------------------------- -----------------•----------•-------•-----------•------------•---------------------------------------•---------•------------•----------•----• ---------------------- -------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed) Ii ----------------------------------- --- ------(Owner and/or Contractor)------ - - ------------------------------------------------------•--------------------•------- Title 1(Plot plan, shoof lot, to ation of system in relation to wells, buildings, etc., can be placed ow reverse side}. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------------------- DATE------------- . - ---- - ----------------------- ------------------------------------- REVIEWED BY ---------------- ---- -- - ------------- `-�---------------- ----------.- DATE- 3 BUILDING PERMIT ISSUED - ------ - ----- -------- ' DATE ----- -- ------------ Alterations _. and/or recommendations:_------.-_........................ ...........\_ - ---.--------••----------------------------------------------------- ----- ------------ -------------- fi -- ------------ ---------- ---------- •------------------• --------------------•---. ---------------- ---------------- ----------------------------------------------------------------- S FINAL INSPECTION BY:-- ------------------------------------------------------ Date------------- ----------- � � �--•� SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street M4 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California E5_4-2M 145446 ATW30D is-Sq