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PERMIT ~ Permit No.�� -- ''�� APPLICATION FOR SANITATION u" (Complete in Duplicate) Date Issued-91-1-4p _51Y 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 Ord•snance No. 549. ` ----------------------- -------------•------- JOB ADDRESS AND LOCATION...____ V-- ------------------ ------- Phon _E-- -h l_. Owner's Name- ----- C :: i r ---------------- Address___ Phot Contractor's Name------ P_ « -.. Installation will serve: Residence Apartment House ElCommercial E] Trailer Court ❑ Motel E] Other ❑ Number of living units: .f..__ Number of bedrooms „ --- Number of baths _,/----- Lot size ------------------------------- Water Supply: Public system Community system [I Private ❑ Depth to Water Table// ft. Character of soil to a depth of 3 feet: Sand E] Grove] [I Sandy Loam El Clay Loam ❑ Clay ❑ Adob Hardpan E] Previous Application Made: Yes E] No New Construction: Yeso No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cess}ool permitted-if public sewer is ava-ilable within 200 feet.] Se tic Tan : Distance from nearest well__----.-____--_Distance from faundatide th--Material---------------------------------------- y ________� No. of compartments--------------------------Size-------•--- Liquidp. Disposal Re Distance from nearest well-----------------Distance from foundation--------------------Distance to nearest lot line---.---_-----.-- Number of lines--------------------------------•--Length of each line------------------------------Width of trench------------------------------- Type of filter materia4-------------------------Depth of filter material-----------------------Total length---------------------------------------- y Distance f m foundation--------------------Distance to nearest lot�ne�.------------ j Se epa e Pit: Distance to nearest well,,r✓ _ -- - � Depth.-.--- { Number of its---.__ _-___Lining materia��Y-ej---Size: Diameter.__ ----------------- p Cesspool: Distance from nearest well_________________Distance from foundation-------------------- material-----_.-.______._ __.___._.._-____._.�, ---.Di Depth ----Liquid Capacity----------------------------gals. n ❑ Size: Diamefer-------------------------------- p Distance from nearesf building--------------------------- Distance from nearest well---------------------- ---------_- - - ❑ Distance to nearest lot line------------------- -------------- ------------- ----------------------- --------------------------- f -� Remodeling and/or repairing (describe):----- -------------- ---------------- - v --------------------- ` -- at ------------•------------•--------•-------•---•-----------•------------------------- k I ! hereby certify thI have prepared this application and that-the work will-be done in accordance with San Joaquin County ; r ordinances, Stat ws, and ruI and regulations of the San Joaquin Local Health District. 1: ---------------------------------- -- -.Owner and or Contractor} (Signed}_ a r tom- (Tit/ Fig -------------------------------- = e� (Plot plan, showing ss of lot, location of system in relation to wells, buildings, etc., can be pl on reverse side, .-. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------------------------- DATE---- -- -------------------- -------------------- --------- DAT7=---------------------------------------•------------------- REVIEWED ------ --- REVIEWED BY------------------------------ ------------ ------------------------------- BUILDINGPERMIT ISSUED-------------•---------------------------------=----•------•------- ---------------•-- DA Alterations and/or recommendations:----___--_--------------------------------------- 4 ----- - ---------------- ------------------------------- ------ -------- --------------------- - _ ------ Date.--------- --- /----- ------------------ ---------------------•---- FINAL INSPECTION BY--------------------- - SAN JOAQUIN LOCAL HEALTH DISTRICT 300 West Oak Street 132 Sycamore Street 814 North "C" Street 130 South American Street Manteca, California Tracy, California Stockton, California Lalli, California ES-9-2M 10-52 Revised W-2100