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PERMIT = APPLICATION FOR SANITATION � Permit No_ r y (Complete in Duplicate) Date IRs ed --- Applica{ion is hereby made to the San Joaquin Local Health District for a permit to constrt _d jAtall the work herein described. This application is made in compliance with County Ordinance No. 549. °] JOB ADDRESS AND LOCATION /-U ''U <�9vZ1 -------------------•------- Owner's Name--------------------- .......... $-?�t�f C7_ f`'-------- - ---------------- Phone------------------------------------ A. Address - ---•-----•--------------- ----------------------• ------•--••------------•--•-----.._.. Contractor's Name-------------------------------------------- ---------- Phone------------ ----------_-------•- ----- Installation will serve: Residence 1g, Apartment House ❑ -Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units:_____ Number of bedrooms-_. 'Number of baths _3-__ Lot size _______,-;�___47'4--- _____________I------------- _ Water Supply: Public system ❑ Community system ElRrivateAz Depth to Water Table -_7-- ft. Character of soil to a depth of 3 feet: Sand ❑1 Gravel ❑ Sandy Loam R Clay Loam ❑ Clay E] Adobe❑ Hardpan E]Previous Application Made: Yes E] No R- New Construction: Yes ❑ No R TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ) Septic Tank: Distance from nearest well__2�-.---Distance fro,m� foundation______--------- Materl_________ _`__________-------- �f No. of compartments-------�-------------Size----�>( -/-y-Liquid depth--------- `�---TUU--Capacity___--- - � Disposal Field: Distance from nearest well Distance from foundation____�'Ot____-Distance to nearest lot line_______S-___.__ Number of lines-._.____2- ----------------- Length of each line---------------------------_Width of trench----------Z_V-_�7!__�-----__-- .Type of filter matarial__+ -_Deptk of filter material____.`-f ti--------Total length____________________7-_--________..__-- Qistance to nearest lot line_- ____--- Seepage P•t: Distance to nearest well_.-'J7�` _-___Distance from foundation.--_ r i ize: Diameter Depth-_-_�-/5------- I. �. Number of pits. Lining mate1 9.nallzo's-� Lining Cesspool Distance Diameter_rom nearest well Depth Distance from foundation Liquid Capacity----------------------------gals. II Privy: Distance from nearest well----------------- ----------------------------Distance from nearest building_-_--_____-__-___--.---__-______-___-_--. Distanceto nearest lot line------ - ------------------ ----------------- ----------•--------------------------------------•----------------------------------------- i r Remodelingand/or repairing (describe):----------------------------------------- ------------------------------------------------•-----------•------------------------•------------•------------ +r -------------------------------- ------------ ---- -- ---••----------- ---------------------•-----------------------------------••-----------------------------------------------•-------------------- ------ � ! hereby certify that I have prepared this application and that +he work will be done in accordance with San Joaquin County ordinances, State laws, and rulesoland regulations of/ he San Joaquin Local Health District. , [Signed)_ L_ -- --------------[Owner and/or Contractor) - -- -------------------------- -- ----- --(Title)------- [Plot plan, showing size of lot, location of system in relation +o wells, buildings, etc., can be placed on reverse side]. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-=�-.-`'---- ---- DATE = REVIEWI D BY ---- ------------------------ DATE. --------------- - - BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE------------------------------------------------------•----- Alterationsand/or recommendations------- -- ----------- -------- -------- ---------••-------------------------------- ---------------------..__..__....----------------•----------- ------------------------------------------------ ---------------------- -----------•------------------•-•--------- ---------------------------- ------•-------------------•----------------------------- ----------------------- ----------- ---------I----------------------------------------------------------------------------•----------------------------- ----------------I-----------------------------------------------------------••----•------------- �. ---------------------------------------------------- ------• ----•-------- --------- ------ --------- - FINAL INSPECTION BY:. 1.[' Date-- -------------` // ------------ --- --------------------------- - � SAN JOAQ{UIN1LOCAL 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 ..t \ C,9-9-2M I45446 A7-OOD 12-54 _ 1\ :1