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P 12 J APPLICATION FdOSANITATION PERMIT Permit'7No -- (Complete in Duplicate) 7 Date Issued Applicafiori is hereby made to the San Joaquin Local Health District for a permit to construct and install the wo / This application is made in compliance with County Ordinance No. 5.49. rk herein described.. JOB ADDRESS AND LOCATION------- r --------------------------- ---� ''� � `' ---------- � ._..x -Y�latr---5o ��A)z. 17s--(c4_s9 ----- Owner's Name---------------A-1--Rorer.----•------------- -- -------------- ------------- - ---- Phone------ - Address-------------- 7 ............. _,16 Name , t -- Phone------:1- 1�� Installation will serve: Residence ® Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of lMn units: _ 9 1- -- Number of bedrooms �___ Number of baths ___-1 Lot size_1�-0�]-,��__-_________________ _ Water Supply: Public system - ------------- Y ❑ Community system ❑ Private ® Depth to Water Table _20 ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ ClayLoam Cia Previous Application Made: Yes No ❑ Y ❑ Adobe© Hardpan ❑ [A� ❑ �{ New Construction: Yes E] No ❑ �"V 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---75_........Distance from foundation-----_ 8- --------Material---- -rl-'C�1@1'2tu-_D?'? VI No. of compartments---------'---------------Size--6 t1}!y.=�' c- '--------Liquid depth --g=�-�------ ---Capacity- �---=------- ----s~300---- ----- ce to nearest lot line--------------- Disposal Field: Distance from nearest well-.--------___--_.Distance from foundation Distan ❑ Number of lines------------------- ------- Length of each line------____-- ------------------Width of french--------------------- Type of filter material__--��---� --Depth of filter material------_ ;� --- -----------Total length-- ------------------•-------------------� Seepage Pit: Distance to nearest welL� 7�_' Distance from foundation-- -- r a �__•____--..Distance to nearest lot line--_-5--______ I Number of pits-__-1-_---_--�' ing material---bZ!iak S' it f -'----.Size. Diameter Depth- Q-----------------� Cesspool• Distance from nearest well-----------------Distance from foundation------------------ .. I Lining,material------------------- S ❑ Size: Diameter --------------------------Depth----------------------------------- -- Liquid Capacity----•---•-------------------gals Priv - '-- .-- � - � ..,,.,. Y= Distance from nearest well "'�` v -_ ❑ Distance to nearest lot line_--- ----------Distance from nearest building----------------_------------ ---------- ---------------------------- - ----------- emodelingand/or repairing (describe)•-------------N-ew---a- al--e�--------------- - + ",__ 1` -------------•--------------------------------------------•-------- J- ti � � ------------------------------ :... -------•-------------------•----------------------------•-----------------•----------------------------------------------------------- ----------------------------------------------------- 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)-----------•-- ------------------------------------------------------------------------(Owner and/or Contractor) By:_ -------------------Pers,-y•_k-j �_ ' Tif (Plot plan, showing size of lot, Iota+ion of system in relation to wells, buildings, etc., can(bele)laced on reveres~ P se side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_ _ __ --- _ + ----------------•----------------------------------------------------------- DATE---,-.8Y _ ----------------------------------------------------- DATE---- BUILDING PERMIT ISSUED---------------- ------ -- -- - - ------------ DATE- ----- Alterations and/or recommendations--------------- --- ----,--------------------- ------------- ---------------- --------------------- =--- ---------------- --------------------------------------------------------- •-- FINAL INSPECTION By----------- --_--_ _ ,� 14.1 -- --'--------------- -------------- Date ----------- ---------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak $free+ 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M Ml Revised W-2104