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�P yAP ?� PPLICATION FOR SANITATION PERMIT Permit No. '1_4 IVX (Complete in Duplicate) Date Issued Applicaa-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 No. 549. Ole 1 - 'rn�A '�. •------ -------- •------------•--- JOB ADDRESS A OCATION___._-" �-�--�----� """"""'""" Owner's Name �• 2�/ ? L(-_ ---- ----------------------------- ----- Phone fes...----- ff .�/ y -.----. .. Address-_ •--------------•---------------- --- - ---------- • � s= �/� Contractor's Name-.. - --_ Phone----.••-. .-----• -----•-----•- -- ------ ------------------- Installation will serve: Residence 2 Apartment House ❑ Commercial ❑ Trailer Court ❑ MotelY❑ Other ❑ �` /---- Lot size ,/� ----ej ---------------•------- Number of living units: __,.__ Number of bedrooms -..__-.=Number of baths / _ �_ _ Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table jJ ft. Character of soil to a depth of 3 fee+: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ErHardpan ❑ Previous Application Made: Yes ❑ No New Construction: Yes ❑ No 2-'- TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 240 feet.) ~ n ._.-. Mahal" r '_Jy Sep#icT __-------Distance from fofdatio Capacity.. D Bl� No. of compartments � -- h - nquid dePt i p`�S Disposal Field: Distance from nearest wek-.Ali- -..._Distance from foundation._-"................Distance to nearer�t line---- ell Number of lines-.:.---.-�----------------------Length of each line----��,O Width of #reach--------- --------- ------------ Type of filter material- .0 ----Depth of filter material__--Af.._-.-.Total length-------•3a._____".--_------.-"-_-.... ' / p S- S ' Seepage it: Distance to nearest weIL. A-e. ._.___DistanceC�m foundation_._._7__�-_-------Distance to nearest line.............._- Number of pits-----1-------------Lining material----1:7.C.-4"- Size: Diameter..... Depth --------- ------------------ Cesspool: Distance+from nearest well_--�Y:"�.y'Distance from foundation------------------- Lining material--.--------_--__--_--._.--:------.- r _Y;: .--- - Liqu�d�Capaaty------- --- .gals.}�J Size: Diameter ---------- ---- ---- - Depth. - _� = a- Privy: Distance from nearest well-------------------------------------------------Distance from nearest building-------------.------.------ -------- ❑ Distance to nearest lot line-----------------..---_ �" """""" �y Remodeling and/or repairing {describe}=------ --- ------------ - -------------------------•---------------------------------------------------------------------------------------------------- -------------------------------------------------------------- ----- --------------------------------1--------------------•-- i __ I hereby certify that I have prepared this application and that +he work will be done in accordance with San Joaquin County ordinancesrS#a a laws, and rules and regulations of the San Joaquin Local Health District. �. (Owner and/or Contracto r -� �1 """..---------------------------(Title)--------------------------------------------------------- By:...............-------------------- (Plot plan,'showing size of lot, location of system in relatft to wells, buildings, etc., can be placed on reverse side). � FOR DEPARTMENT USE ONLY . APPLICATION ACCEPTED BY------- -- ------------------------ ------ DATE---------- - /sem � .---------------- REVIEWEDBY----------- --------------- ----------------------- - --------- ----------- ----------------- ----------------------------------- DATE--------- -•-------------------•--------------------------- BUILDING PERMIT ISSUED------------------------------------------------------------------------ ------------•----------•----- -::-^----------------------------- DATE------------------------------------------------------------- �• Alterations and/or recommendations---- ---------- ----------------- --- ------------- -------------.-.------------------------------------ -------•---------- ------- -------------------- -------------- ------- ---------------- - FlNALINSPECTION BY------------------ ------------------------- Date...--------------------------- -------------------------------------------------- SAN ----------------------------------------------SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C' Street 1k Stockton, California Lodi, California, Manteca, California Tracy, California 1 ES-9-2M 1e54,6 A7WOUD iz-sr l —