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k P M OR SANITATION PERMIT Permit No. ... ---- '.� APPLICATION F / T1� D (Complete in Duplicate) p � Date Issued ---•- E• rrGf�( Applica}ionrihereby made to the San Joaquin Local Health District for a permit to construct and install the wor r ' describe . This application is made in compliance with County Ordinance No. 549. f77_� -O� �- JOB ADDRESS AND LOCATION.--- �` '�+'' ` -------"- � ` ' Phone------------------------------------ Owner's Name----- -�-"-------- - - - ------------------------------------------ ---- --- Address r`r ^r :----------- --- Name--- �- �------ Contractor's - -� ---------------------- Phone -- Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer.__. _ Lot size ------- Court E] Motel ❑ Other -- --- Number of living units: ___ Number of bedrooms _._ Number of baths dr Water Supply: Public system ❑ Community system ❑ Private '"Depth to Water Table .1e. ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: Yes ❑ No New Construction: Yes Pq"No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public fewer is available within 244 feet.) ��y ---------mate�al _ =- T----------- . �' Septic Ta Distance from nearest wel _��_..__.Distance fro foundation_._ - - - Capacityi?�" $iz _ � No. of compartments-.-_-- --- e x ,ir - iquid depth_.------- - oe ....yy Disposal Field: Distance from near st well__;K- 7-_. -_Distance from foundation-_ _.._----___.Distance to nearest 1Qt lin�f________________ dumber of lines--�-----' ------- /--Length of each line---I ------------------Width of trench---. -- N------------------- Type of filter material_/4A—r'�-------Depth of filter material--_- f- f-r-.-..Total length__�_" � --"--------------- Seepage Pit: ~ Distance to nearest well----------------------Distance from foundation----.-__-_--:_--_-_Distance +o nearest lot line-_____________.__ ❑ Size: Diameter----------- ------ Number of pits--------- -----------Lining material---- ----------_ ---. --------Depth---------- -------------: Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material _--.-"-.--_.----._-.-----_____-----_ ❑ --- ----Depth --------------------------------------------------Liquid Capacity----------------------------gals. Size: Diameter_________________________ __ { , Privy: Distance from nearest well-------------------------------- --"-------------Distance from nearest building------------------------------------------ Distance to nearest lot line"--------- ---- ----------- ----------------------------- Remodeling and/or repairing (describe): "------:� CT`s L ' --•--------•---- .._: � �'- ----- -----•---------------•------------------- ---------------------------------------------------- ----------------------- ------------ --------- ---------•---------------------------------•-----------------------------•------------•-------------•------------------------------------------------------------------ 11 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. C / or Contractor (Signed)------- •--�' �-• - - �3�_•.,�- -"""- --- - ,eic - �-`-'-'��---------------- ---------------------------•------ (9vr�•iw7srf� �' _._Title l' Cr '. � ` (Piot plan, showing size of lot, l0qllollon of system in relation to wells, buildings, etc., can be placed on reverse de). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----_--._ - DATE------- __- _ REVIEWED BY------ ------------------------- t ^�-r ---------------- DATE DATE. BUILDING PERMIT ISSUED--------------_--- ------ Alterations and/or recommendations:------------------ --------------------------------------------------•---------------- ----------------------------------•-- ------------- -- FINAL INSPECTION BY:. _.- .____ .---------- Date__.. / `� SAN JOAQUIN WCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton. California ' Lodi, California Manteca, California Tracy, California Eg] 145496 aTwooD