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q l 1 ""r APPLICATION FOR -.ANITATION PERMIT Permit No. . ..-..3 a_..- (Complete in Duplicate) �j r Date issued .Applica+ion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. `his application is made in compliance-with County Ordinance No. 549. iDJUL JOB ADDRESS AND LOCATION_-_ --- ' Owner's Name.------ ---------------------------------------------- - ------------- -- ----------- ----------- Phone-.,,-..b rt L Address-------- t ~------------------------------------------------------------------------------•-------------------•-•----•-------------------------_------:,j-------------..... .... Contractor's Name----1---- .. . - -- ----••---•-- Phone-- -L..L..Q� ' Installation will serve:. Residence [Apartment House ❑ Commercial ❑ Trailer Court [],,Motel ❑ Other ❑ Number of living units: .--1 --- Number of bedrooms -'Z. Number of baths ---1..-- Lot size / -0-- --1- ----------------------------- Water Supply: Public system Community system El 'Private L] Depth to Water Table Z5 ft. Character of soil to a 'depth of 3 feet: Sand El.. Gravel I-] SandyLoam ❑ Clay Loam ❑ Clay❑ Adobe Hardpan ❑ ' Previous Application Made: Yes ❑ No W New Construction: Yes 9-- o ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: E (No septic tank or cesspool permitted if public sewer is available within 200 feet.) s Septic Ta : Distarice from nearest well--;-----------------Distance from foundation--------------------Material------------------------------------------------- i . No. of compartments--------• --------------Size--------------------------------Liquid depth-----------------------. Capacity..--------------------- Disposal Fiel : Distance from nearest well-------- ------Distance from foundation-------_-..-.-----.Distance to nearest lot line----------------- ENumber of lines-----------------------------------Length of each line- ------.Width of trench----------------------------------- Type of filter material-------------------------Depth of filter material----.-----_----_---_-Total length--------------------._-.----..-.__--__---- Seepage it: Distance to nearest well_-.!`�?"—--_---Distance frog] foundation-- .---. Distance to nearest lot line----------------- ------Linin material-- " -----:Size: Diam er- --•` -�.-------_---Depth_--2 ----_-----. Number of pits.....{,----_---- g ------•--- esspool: Distance from nearest well-----------------Distance from foundation------------------- Lining material -..----..---_------,_--------.-_----- \ . ❑ Size: Diameter-------------------- ---Depth- ----- Liquid Capacity- -------------------------gals. Privy: Distance from nearest well .--Distance from nearest building g - ❑ Distance to nearest lot line-----------------------------•------------------------------------------.-...--------- -----•---------------•f--------------------------------- Remodeling and/or repairing (describe) - "`� •----------------- -------•------• ---------------------•----------------------•---•- ------ -- --------------- ---- •------- ----------------------------------••--•------------------------------------•---•-----------•-----------•------------------------------------------------------------------- I hereby certify that.l have prepared this application and that the.work will,be done in accordance with San Joaquin Count71 ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signe_ ----- Q"--_ !l1 -----.--•--- ------------(Owner and/or Contractor) (Title)-- ------- By: - )u.:--`:.. -p ----=---- 9 �`1.. �.• = ------------------------- - ... ---- (Plot Ian, showln size f lot, location of system in relation to wells,.buildings,.etc., can be placed on:reverse Nei).&9.0 FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY--------- ------------------- --- ------- ---- -----------------------:------------------------ DATE--------�------ ------------------------------------ DATE =� ., REVIEWEDBY------------------'------------------- --- --------------------- ---------------- ----------------- -------------- r' __` BUILDING PERMIT ISSUED _ *- --------- -- DATE------- ----- :� Alterations and/ r om ndatio --- ----------------------- --------- ---- -:. - -�-------------------------------------------------------------------- -- f ---------------------------------------------------------------------- -------------------------------- E i. - FINAL IN5PECTION BY:.__ �. �- -----= Date.....:.:. .... (/ � _ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814-North "C" Street Stock+on, California, Lodi, California Manteca, California Tracy, California ES-9 - 145446 ATw000