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APPL(CA7I6N FOR SANITA�'oiT PERMIT Permit No. _fI_ - (Complete in Duplicate) ' I Date Issued �14__'7_� _• 'S_��f Applica*ion''is hereby made to +he San Joaquin Local al Health District for a permit to construct and install the work herein described. This application is'made in compliance with County Ordinance o. 549. r � JOB ADDRESS 1N LOCA+TTO �� ---------------- ----- -----`-�- -------- Owner's Name --------•-- t�- ---- Phone__T---L - - Address-----z__a r - -- ------ - ------ ---- Contractor's Name-- c.�(� �} Pho - I Q.. °4��_� --- --------------------------------- ------- -= Phone_- ' ---------------------- Installation will serve: Residenc w Apartment House ❑ Commercial ❑ Trailer Court ❑ otel�❑ Other-❑ Number of living units: __ ._ umber of bedrooms umber-_9,epth baths, ___� Lot size _____ - __ ' a* � ,qt ------------------------- { Water Supply: Public system Community system ❑ I'riw to [) to Water Table -------- ft.,' Character of soil to a depth of 3 feet: Sand Gravel ❑ Sandy Loam Clay Loam Clay f Y ❑ y ❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑ No New Construction: Yes V�No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if ublicsewer is available within 200 feet.) ✓ Septic ank: dot of tom artmentse from t well--.µ _Distan )fro - ,,and . ;on--------------- ._.Material __ .z p Size- � ------ ------------- -tqu de th- ------�f"-- _ +�,t Capacity 'i f � Sj �y,T �/ _ Qis osa,Field: Distance from nearest w II_ _ 11 Dis+ante trom�aundation___'�-`t`--------- p Distance to nearest lot I' -re�---___ - Number of lines __________C._.-- Length of each line__--__ j Type or filter materilr.----s--------„ Depth of filter material____.___C Totalthlen.length nth _r� =--_-= &� See pa Pit: - Distance to nearest w II_____ _ ine Number of its--_______ ____ ____Linin mD}stance rQm f nda#ion _--__-- __.Distanc to nearest lot line__-_._______i- P g erial- ---Size: Diame+er Depth__. _- _ Cesspool: Distance from nearest well---_____-___-__Distance from foundation.- ____--,_-- Lining material___________ ________ ___________i ❑ Size: Diameter--------------------------- - -------Depth----------------------------------------------------- Liquid Capacity---------------- Privy: ------------gals. Distance from nearest well-________________ ______________________-------Distance from nearest building _________ ` ❑ Distance to nearest lo+ line_ --------------------------- v -------------------- ------------------------------------ Remodelingl�no/or repairin (describe):_(-_- ► 1 j � �( /' =---------- ------------------••--- -••------•----- "'�----- �" _ ------ ---•------ - -------------------------�-•--- -------- --- -- --------------------------------------------------------------------------------------------------------------- ---------s----- ------------(------ ------------------- .�, -- - - ---- - - -- ----------------- ------ ------ - --- ----- ---- - - 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)_ �.--- • , t � �..- _ (O�wner and/or Contractor) or)BY:------- ----------------- •-------------------- _l, = . Y---------------- ------------------- (Plot plan, showing size of lot, location of system inreaton .wellsbuildings, etc., can,be pla ed on reverse side). FOR DEPARTMENT USE'ONLY .� APPLICATION'ACCEPTED BY-- ----------------- A` DATE-.Ig + o- S REVIEWEDBY---- ------j- ---- - ---------------------------------- BUILDING IV.. A ----------------------------------- --------------------------------- --------------------------------- DATE__ ---------------•-------•----------------------- BUILQING PERMIT ISSUED --------------- DATE.------ •• I ----------------- Aiterafions and/or recommendations:-'_____--_-____-_- '-------------- ----------------------------------------------------- ------ ----------------------- --------------------- -------- -- - --------- FINAL INSPECTION BY: - - - ----------------------------------------------------------- --- -- ---------------------------------------------------- r� ----- --------------- Date-- --!_.(-/-/_T ------------------------------= SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street y 'k132 Sycamore Street 11 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-21A I Revised W-2)00