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, APPLICATION FOR SANITATION PERI IIT Permit No. (Completein Duplicate) 4,14 Date..fssued .. Application is hereby made to the San Joaquin Local Health District for-a permit to construct and install the work herein desc This application is-made in compliance with County,Ordinance No. 549. JOB ADDRESS AND LOC ATt / , r ._; . Owner's Name.....,... . .. •-- ----- ....- Phone.. . jV Address _ p ^. +,. ot, Phone: , Contractors Name - _ ---... . Installation will serve: Residence Apartment ouse ❑ Commercial ❑ Trailer Court ❑ Motel Other Number of living units: ________ Number of bedrooms . . Number of baths -------- Lot size __. _ _ Water Supply: Public system V-1co ommunity system ❑ Private ❑ Depth to Water Table -------- ft. Character of soil to a depth'of 3 feet: Sand Gravel Sand Loam Clay Loam Cla ' Adobe Hard an" ❑ ❑ Y ❑ Y ❑' YCI p Previous Application Made: Yes ❑ No w Construction- Yes VfNo ❑ ; TYPE OF INSTALLATION AND SPI�IFICAT16NS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) 44 Septic Tank: Distance from nearest well-__-________•:---Distance;from foundation----_______________Material-------------_-- 171 ______-__.❑ No. of compartments--------------------------Size,-------------- -- ---__Liquid depth---- - -------------Capacity-------L',_..... ,` , Disposal Field: Distance from nearer well % ' . _.Distance from foundati `. _Distance to nearest lot line._] Number of lines,_ _&.14, Length of each fine._._ t Width of trench ._ aF Type of filter mate rial__A Depth of filter materia:._ .......,_.._.Total length:._40 .:.___, � Seepage Pit: Distance to nears I ,well,_ Distanee fr sn tion-.-7.4 X- ___..Dist*ce to nearest pr Fes'"' g ------ P � •--_- Number of its_,_ __._. ... Linin materiaL__ ,_ Size: Diameter_.___ Depth Cesspool: Distance from nearest well.................Distance from foundation------..............Lining material-_---------------------------- Size: _ .-__:-•-_ __-_._-_.___Size: Diameter Depth , quid tY -- ----- Privy: Distance from nearest well•••______________________ ________ ________Distance from nearest building------------ ._-,, . L.-..,..- . ❑ --- ` Distance to nearest lot tine--------• -------- ---------------------- ----------------------------•-----.__--------- ----•---- ------:-... .__.__ - ° Remodeling and/or repairing (describe): - A�?�?<------- - •----- f - ---•- -- -•-•-=---------------------------------------------------------- -- -----•-•---- ---------- ---------- ------- - ---•-- --=...................--.............. � I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin C ordinances, Stat laws- and`ru and regulations of the San Joaquin Local Health District. S� reed " _, _, fl �9 ) ..... ^!G (Owner and/or Con ire By:-------- -- -----------------------------------------------..-----• . ---(Title)---- - -- ----- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be place on Lever side).. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY..... ----- ----- ----- --- --- --- --- - ----•-=- DATE- t,. .e. .................. REVIEWED BY- --- ---- ---------- DATE_ ,tom. , BUILDING PERMIT ISSUED--- ----- ------ DATE._ ..------ ----- Alterations and/or recommendations- -1 ------ ------=- - ------------------------------------ --....................................�.. ------------------------------- -------- -------- -- - -------------------------- - FINAL INSPECTION BY:- ---- ----------- ----------------- Date---- - _-,. ... . SAN JOAQUIN LOCAL HEALTH--DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street M North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ° ES=9-2M'8-51 Revised W-2100