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Perm APPLICATION FOR SA { NITATION PERMIT it No. .__f -�-�-Q Complete in Duplicate) Date Issued _-/L / ' perm to construct and install the work h rein described. Application is hereby made to the San Joaquin Local Health District for a p �� This application is made in compliance with County Ordinance No. 549. f p , { JOB ADDRESS AND LOCATION.---- ------ // �+ ----------- -- -- Phone ---r-�-�-'1�"- ----- Owner's Name - "�' �'��- ��`` ""7n._ - ---------- - %/ y Address-------'=,C 4'-`------------- 1 PhoneN _ = s (t �, ------- } Motel ❑ ❑ Contractor`s Name"-_Ek��•�=--�----•=-'` ------`-�-}-------�--"-"""""- Other artment House ❑ Commercial ❑ Trailer Court ❑ Installation will serve: Residence Ap _-- R. �R=_"!_"_""---------------------- Number of living units: ---I_-- Number of bedrooms __� Number of baths ---I--- Lot si 3S I system ❑ Community system ❑ Private [0 Depth to Water Ta 1 fj a b Hardpan ❑ Water Supply: Public y k Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam,®` Clay Loam ❑ ay ❑ No ❑ New Construction: Yes ® No F1FHA/VA: Yes El Previou E s Application Made: Yes ❑ No F1 TYPE OF INSTALLATION AND SPECIFICATIONS: i (Na septic tanklor cesspool permitted if public sewer is available within 200,eet.) _ r-Material --" c - Septic Tank: Distance'`from nearest ------ 4:from foundafion_ 4� Ca aci Li uid dep�� ------ p tY Size_----�---- -- - �-------- G 1 ® No.tof compart dent F isposa Field: Di Stance from n�ar�s.f wel, _ ---.-.Distance from foundation --� D�at4�cofttrench------�-I� ---- ----- 'Len th of each line:'____ -6- -------- Number of lines-------- ----- g ��_ _Total length---------- - 4- De th.of-filler material `` �" Type of filter material'' P >' —'- y c crest .xre�!� I i Seepage Pit: Disfance,fo nearest well--_/-0 -``-'Distance from foundation_ � /"Y RO Number of'pits_,t.-�-- Lining material -- -Size: Diameter- '_- --:__--Depth- --- f [ s'E;{ k I Linin material-- Cesspool: x Distance6'from nearest.�well"-_""- _"_""--__Distance f�m foun ation_"" __-____"_._-___ . g ' als. �; th _`'-------- ----`--- ------------ ------------- Liquid Capacity ----- ------- -- --- V ❑ Size: Diameter----- ----------- -- --------- De p o Distance from nearest ,well. ""-__"-_____.��-__�'- --- t--Distance from nearest building__ Privy: �. -------------------- ------- ----------- -------- - ------------------ � i Distance to nearest lot ------------------------------------- El ____._---- --- k • � Remodeling and/.or repairing (describe:-_t'c � ---------------- ---------•---•------------------------------------- ---------------------- 4 - ----------------------------- ------------------=-------------------------- 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. = i (Owner and/or Contractor) (signed) 1 ° Q ------ ----------------------- -------------------------- By: --- ----- --- ----` - - - i (Plot plan, shawin ize o Flo ;•location of system in relation to wells, buildings, etc., cin be placed on neve a side]. FOR DEPARTMENT USE ONLY i DATE----- - - --- ---- - ----------- ---------------------- ------ --- - ------ - APPLICATION ACCEPTED BY DATE----- r -- -- ----- - - -- - -- -- - ------------------------------ REVIEWEDBY-------- ------------------------------ F - DATE------------------------------------ ----------------------- BUILDING PERMIT ISSUED-------------------- ;. ------ -------- -------- --- --------------------•------------------ Alterations an /or recommend�ti n --------- - ------------------------------ . _ `. ------------------- ------------------ 4r / r ff. " rx eS ----------------------------------- ------ ----------------------------------- -------- ---------------------- ---- ----------------------------------------- ---- i --------------------- ------------------------- - . -- ------------------- -------- t FINAL INSPECTION BY:.---- - ta --------------- Date----- - -. SAN JOAQUIN LOCAL HEALTH DISTRICT 132 Sycamore Street 814 North "C" Street 130 South American Street 300 West Oak Street Tracy, California � Manteca. California Stockton, California Lodi, California ES-9-2 K4 Revised 1.57 F.P.CO.