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avQQ'i APPLICATION FOR SANITATION 114T4! Permit No. ...D.__.. ...�?. __. (Complete in Duplicate) Date Issued _ _,___/_Z__9 Applica ion is hereby made to the San Joaquin Local Health District for a p rmit to cons ct and install the work herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION. ----- '-------------------------- ------------------ -- ----------------------------a ----r�-----c? fl---z/ Owner's Name---------------- == -- - ----------------- -------- ---- Phone------------------------------------ Address------------------ ---- ------- ---------- ---------------------=---------------- -------- r - Contractor's Name---- ____-• - ----_-•- --- Phone-- - _ - _ Installation will serve: Residence" Apartment House ❑ Commercial ❑ Trailer Court ❑ Mo I ❑ her g;--- Number of living units: __f _ Number of bedrooms ___ umber of baths _ -Lot size __,Ml+_________________.__.___._______-`___________.- Water Supply: Public system ❑ Community system Private ❑ Depth to Water Table `s'_77 ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Clay Loam 0 Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: Yes ❑ No ❑ 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__) _ 'C�.Distance wfromfoundation_____ _Q__�t._Material`_�_�_. --- _ - �] No. of com artmenis_____ - . Size______ t - Liquid deep}th Capacity d n0 bo _XZDisposal Field: Distance from nearest well'_J010�-Distance from foundation----j_G!_ ____Distance to nearest lot line_________________ Number of lines___________ _ _ _ .______Length of each line____ _� ; Width of trench-----� - _ ------------------- %Z i -------------------- Type of filter material 1 _. Depth of filter materiaL__.fII`-______. Total length______�f_�_._______- --------------- Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line___________.____ fi ❑ Number of pits----------------------Lining material-----------------------Size: Diameter---------------------- Depth--------------------------------- x Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material----------------- " ❑ Size: Diameter--------------------------------------Depth-------------------------------------- -------------Liquid Capacity-------- ----------gals. Privy: Distance from nearest well------------------------------ ------------------Distance from nearest building______-___---._____________________.___. ❑ Distance to nearest lot line-.------------------------------------------------------------------------•----------------------------------------------------------------- Remodeling and/or repairing (describe):-------------------------- ----------------------------------------------------------------------------------------------------------------------------- --------------I--- ----------------------------------- --•--------------------------------------------------------------------- -----•------------------------ ------------------------------------------------------------------------••------------------------------------------------------------------------------------------------------ '• r 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)----------------,Jd- ------ - - ------ - ---- ------- --------- ------- -------- -- -- ---- w errnd/or Contractor) B • Y• � '-- ---------- h �-�------------- (Plot pian, showing size of lot, locat n of system i relation to ells, buildings, etc., can be placed o reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------------- ------ ------------ ------ -- t,A ------ •----------- DATE---------------- REVIEWED BY------------------------------------ ------ ---- ------ - DATE-------------lL��I r' BUILDING PERMIT ISSUED ------------ DATE - V Alterations and/or recommendations:---------- - - ------------ .•.,t.- ----------------------------------------- ----- ----------------------•------------•-------- �V - '�_N!/?A r------------------- 11�--- �1 _-. �" t1V._. �' ,� ----.Q_._&-�------ ------eQ-A- i/14Al.._AJA72Z --------- -- ----------------------------------------------------------I------ ---I------------------------------------------------------------- ------------------------------------------------------------- ------------- FINAL INSPECTION BY:-- W Date--- S SAN J2QUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M Revised W-2100