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\\71 APPLICATION FOk 1,ANITATION PERMIT Permit No. ._.6.y...... (Complete in Duplicate) bate Issued ___ _br Applica}ion 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 N . 549. ---------------------------------------- JOB ADDRESS AND LOCAT ON_... -L c�- /!�" - --- -------------- ------ v -------------------------------------------- --------------- Phone_/ -a�,,Q Owner's Name--- _ Address----- - -------•----------------------------------------'----------------------------•------------------------- ❑ Ph - Name--------P.?-..�. ----'L-----v--�''-C-..'------------------------------ Contractor's - - - Installation will serve: Residence-,n Apartment House ❑ Commercial ❑ Trailer Court Motel Other Number of living units: __[__._ Number of bedrooms ______J_ Number of baths __/___ Lot sizes------------------------- Water Supply: Public system E9 Community system ❑ Private ❑ Depth to Water Table ---------ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑ No 9 New Construction: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) y Septic Tank: Distance from nearest well________________Distance from foundation--------------------Material------------------------------------------------- 15 W7 ____-.._____-_-_.___.-______-..____.___--.__._.ISW7 No. of compartments--------------------------Size--------------------------------Liquid depth--------------------------Capacity------------•---------- Disposal Field: Distance from nearest well------------------Distance from foundation---------------------Distance to nearest lot line____._-______--._ q Number of lines-----------------------------------'.Length of each I••sne------------------------------Width of trench-------------------- Type -------------- {" �1 c',�/�/ ---De Depth of filter material------_ -- _Total length---------------------------Q� ------ Type of filter material----------------- p - ------- --- - /0'�--_----.Distance to nearest lot --------- Depth _______ Seepage Pit: Distance to nearest wei{---�J?-�:`�__._Distance f om fo ndation - ,- Number of pits______.-____._ Lining material. __.Size: Diameter----j _��-'--__Depth----- -—9 ------------ 701-1- ---------- Cesspool: Distance from nearest well-----------------Distance from foundation_-,-----------------Lining material__._______.___ - �_�-________ • Size:- ---- -7 p �" '�. ""``n"Liquid_CapacitY gals. ❑ Depth - - .-- -Distance from nearest buildin --------------------------------------- Distance ---------- - Privy: Distance from nearest well------------------------------------------------ 9 ---'----- --------- ❑ Distance to nearest lot line----------------------------------------------------- ----------`----------------------------------------------- ' � --------------------------------------- Remodeling and/or repairing. (describe:______-'-'-�! Z� --'-------- --- •-•------ ----=---- --y- --- ------•--------------------•-"----------------------- ---------------- = 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; n rules and regulations of the San Joaquin Local Health District. • caner and/or Contractor) (Signed) •,� -- ---------------------------------------- ---' ----- Zd :�4 /� Ti+le (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be plere side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY - --- ------- DATE -- --- ---------------------------------------- REVIEWED BY ------------ DATE _-�? -mac ------------ --- -- -- - - -- BUILDING PERMIT ISSUED----------------------" ----------------------------------------------------- ---- DATE �Y Alterations and/or recommendations---------------'----------- -- - ...------------...---------"-•---------•-----------•-------••--------------...----- ----------------------------------- r FINAL INSPEC-TION�BY:.:__-_- -- =-"`= ` Date"- '"'.w �-'- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 3o0 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2m ; ' Revised W-2100