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APPLfCATION'FOR SANITATIOWPERI* Permit No. O' 9 lien"ieate .3 y (Complete r� ) Date Issued Applica+ion is hereby made to the San Joaquin Local Health District fora permit to construct and install the work herein described.. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION_ 1 Owner's Name------ .••. Phone -. -- Address-------,P2._---Z.......5el:..--- -- ---- -•............. --•-- Phone. - Contractor's Name---..:_-R11&-&=-:�- ................ ---------- --------- -----------------------------------------------> '•--- �� -----•-----... Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ N . v.�.+��-- . -„ ---- Number Number of bedrooms -�- Number of baths ........ Lot size _.1.-��^ X. , S--------------- -------- Number of living units, Water Supply: Public system Community"system ❑ Private ❑ Depth to Water. Tabley.vft. Character of soil to a depth of 3 feet: Sand Gravel E] Sandy Loam [:] Clay Loam ❑ Clay❑ Adobe[•- Hardpan ❑ Previous Application Made: Yes F] No %w Construction Yes TYPE OF INSTALLATION AND SPECIFICATIONS: , (No septic tank or cesspool permitted if public sewer is availAW within 200 foe#.) so fan : Distance from nearest well foundation from foundaon ....... _:Material No. of compartments--_. ----..>.._.. _.._Slee -_ d4pth--.------ ---------------Capacity ------------------ Disp Field: Distance from nearest well-----------------Distance from foundation......... .........Distance to nearest lot line................. W Number of lines.' Length of each line ______________ Width of trench Type of filter material___ """T Depth of filter matri I Total length..._.. 43 Seepa Pit: Distance to nearest well_ �--"_Distance from fou 'da on--._3.�., Distance to nearest lot`hne-.. J...... Number of pits-- �_._.._ Lining material... ............ .Size Diameter . '. =_Depths i Cesspool• Distance from nearestxwell___ ....... :.Distance from foundation......... ......... Lining;material.... _._..._....................._ ❑ Size: Diameter------------------------------------"--Depth----- Liquid Ca acY -•--- 9als. , Privy: Distance from nearest well-_-.___ ___---------------------_-------------Distance from nearest building-.':.__------------------ ............ ❑ Distance to nearest lot-tine- ---r -------- -------- --•--- .-w,-- •'-----•-- ,......_............... Remodeling and/or repairing (describe)-------------------------------- ....................................... ------------------------------------------------------------............................................----------------•- -----------------------------------------------................................. ----------------------••--••----- --- --.----- -------•••---•----•-•-----•--•... --•----- -- -•---------•---........................................ w............ • --------- t ,, ---------------- --------- --- ----------------------------------------------------------------- ----- x -•---- ----- - ----- ------- - I hereby certify that I have prdpared this application and that the 4k will a don in accordance with San Joaquin County ordinances ate laws, and rules regulations of-fhe San-Joaquin Local Heal District. 1 (Signed) -- ----- '---- . •-- .....__... • -- ------------- -x-- --- ---- --- - ----------• -- sand/or Contractor) BY• - - ----- ....._._( i#le) . (Plot plan, showing size of lot, locafkn of sy m in relation to wells, buildings, etc., n �e placed on reverse side). ;. . FORbERARTMENT � APPLICATION ACCEPTED BY "J? tH -- --------- FATE... . ..1 REVIEWEDBY-------------------------------------------------------V-- ----- ----- -- -------- -•-•----- DATE --•-- --•-- ......--••--•-----... -•------- BUILDINGPERMIT ISSUED ----------------------........................... -------- DATE............................................................ Alterations and/or recommendations.... -•--- _--------- - --------- -------- ........ --.. ........ ..........•.......... ................... ---------------------- --------- ------ ----- -- �j2 FINAL INSPECTION BY:----------- Date---- . .... -- .................................... SAN JOAQUIN LOCAL 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 ES-9-2M Revised W-2100