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1 � a ' XPIPES ONE YEAR APPLICATION FOR FROM DATE r SANITATION PERMIT Permit No. (Complete in,.Dup_.licate) s (Q Date Issued --- R � Application 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 No. 549. JOB ADDRESS LOCA71 DN------- " � - ---: . Owner's Name--- ----------------------- --• ---- Q/�U7A, Address-----------�--�--7-�----=------- ------ (( t ' ----- Phone ' ---- ----- ----- ------ ------------------- Contractor's Name___._______ ., —/ - - --------------- ------------ - ------ ------------------- Phone-----••--------------------------- Installation will serve: Residence 2 Apartment House ❑ commercial ❑ Trailer Court ❑ Motel ❑ Other Number of living units: Number of bedrooms _ -" Number of baths _� �! I tc� per oeLot size . Water Supply: Public system --" ------"""""" pp y� y , Community �ystem'0'^'�Private [)ADepfh'to Water Table ft. i Character of soil to a depth of 3 feet: Sand Gravel ❑ Sandy Loam i ClayLoam Cla Previous Application Made: Yes ❑ -No ENew Construction: Yes No PHA/VA: Y y ❑ ..Adobeardpan ❑ ❑ / es,❑ No TYPE'-OF INSTALLATION AND SPECIFICATIONS: ' (No septic flank or'cesspool permitted if pu61icw,er is available within 20`0 feet.) ' f Aiw Septic ank: Distance from nearest well-9-0------_Distan fro fou �iationlD _.Materi � No. of compartments---------- X ; fSize Liquid depth . - -- ------------Capacity---- V� ! Disposal Field: Distance from nearest w llI, — ---__"-,_Distance from foundation" i �r j _Distance to nearest lot line_ _- J Number of lines----------- --- _ - -"---Length of-each line.____-____ -_Type of filter materi Q tp -Widt{� of firench__-___"-"". 1 :+ - _______Depth depth of`filter"mate�iai_ 'r- '--' / j - 7btat length_ -----------------�----- Seepago Pit: Nu ante to nearest well___ ___________Distance from foundation----------- to nearest lot line__.-____._-_-_._ 'j ❑ Number of pits ---------- Lining ma#aria/ size: Diameter"''"__`` T"Depth I ;Clrlesspool: Distance from nearest well ______________Distance-from foundation- _-__-__..Lining material__.-___.. r � ❑ Size: Diameter-- ----------------------------------Depth ----- - - f W T Liquid Cap'City----------------------------ga s. Privy: Distance from nearest well`_`..__--"�"'� ''-- _ - .• ancrom nearest �..{_ : Diste'f °buildiii9- ❑ Distance to nearest lot line____-______-_--"_ I Remodejing and/or �iriescribe:_ - " ---------------------------------- g, ._ ------------------- :- .� / Y D� - -------------------------------- - ------- ----- ------ ---- - _` !- _ --- ;; ------------------------------------------- ----------------------------------------------------------------- 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 iules and regulations of the San Joaquin Local Health District. (Signed)------- (Owner art r C t t ) By:----------------• - - - on rat d/o or --- - ------------------------•--------------•---- „�. (Title) - ' (Plot plan, showing size of lot, location of syst relation to wells, 6uildings, etc., can be placed on reverse side). 5 FOR DEPARTMENT USE ONLY 3 APPLICATION ACCEPTED BY- - --•--- DATES- REVIEWED BY ,-� --"-------------- 1 ---------- ' �J. ` ------------------------------------------------------ BUILDING PERMIT ISSUED---'.--•--- DATE ------ ---------------------- --------------- DATE - ---------------- ---------------------------------t--�----------- -------------- aerations and/or recomme dations:___-___.__-_ ------------ --------- --------------- _ zee�- 6 -.:�ccc --------------- ---- --------------- �- �. -------------- - ------ FINAL INSPECTION BY--------- ------------ _. ~-Date---.�- ---------- --------------•--- SA CAL � '¢' 1N L",. . -r`� TR CT lJ " � � . 130 South American Street � � .� 300 West Oak $arras} 132 Sycamore Street US, Stockton, California 8!4 North "C" Street/ Lodi, California Manteca, California Tracy, California old '} ES-9-2K4 , Re sed 1.5t77�F.P.COO.