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1 5--110� ✓' , APPLICATION FOR SANITATION PERMI Permit No. _ t n Duplicate) (Comple e i 7,v Date Issued 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 Ordinance tio. 549. JOB ADDRESS AND LO-9 TION�f R + B_ 6�..�i ---------------------------------------------------------- ------- Owner's Name----------�rw►_Q.B----lz �� Phone ., Address.......................................... . - --------------------------•--- •. ---•• ----------------------------------------------------- ----------------- Contractor's Name._____ -__. ... �- __ Phone Installation will serve: Residence ix Apar ment HouseCmmercial E] Trailer Court E] Motel ❑ Other ❑ roomsS/.-Number Number of living units: __1___ Number of bedof baths ---t--- Lot size ..... �C _ _`__________________ Water Supply: Public system it Community system ❑ Private ❑ Depth to Water Tableft. 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 ❑ NFHA/VA: Yes ❑ Noj TYPE OF INSTALLATION AND SPECIFICATIONS: �` (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) -S—ei-D�fic Tank: Distance from nearest well_gtW oo Distance from fon ion---ZID----__.M ______________________ __ ____________ No. of compartments___�''-------------Siz __ __Liquid depth__ _ ____Capacity..ZPV- sal Distance from nearest well_________________Distan f9m foundation_______-______-___.Distance to nearest lot line----------------- Number of lines__________________________________Length of each line------------------------------Width of trench_-_._______________.__-________ Type of filter material_________________________Depth of filter material_________ ____________Total length------------------------------------------ Seepage ___________________ ---------------------- � epage Pit: Distance to nearest well--- _.__Distance from foundation____ .10........Distance to nearest lot line__.______ Number of pits_____I--------------Lining material-_ifit --------Size: Diameter____ 3�� Depth___ , _�____.__________- e Cesspool: Distance from nearest welL________________Distance from foundation--------------------Lining material_____________________________-____ ❑ Size: Diameter-------------------------------------Depth----------------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well--------------------------------------------_----Distance from nearest building------------------------------------------ D to nearest lot line - - m deling and/or rep . . (desc be):- -------- ------------------------•------- - L 1 ---- ---------------------------- ----- ------•----eereby - - ----------------------• -------------- -----------------------------------------------------------•----------------------------�----------- ----•------------------- 1 ce ify that I have p ared 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. _ A - (Signed) �' 4 - ------------------------------- Contractor) By:--------------------------------------------------------------------------------------- ----- ---- --- T le)--.------------------------------------------------------------- (Plot plan, showing size of lot, location of system in rela ' n to ells, buildings, etc. an be placed on reverse side). ` FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------------------------- ---------------------- ------------------------------------------ DATE----- ---- --� - ------------------------ BUILDING PERMIT ISSUED------------------------------------------ - -- - - ------------------------------------------- DATE------�------ i REVIEWED BY------------------ ---------------------------------------- DATE---- Alterations and/or recommendations------------------------ --- ---------------------------------------------------•------------------------------------------------------------------------- ..- - . /" - - - ------ --- ----- .._ -- -- - --- - '--------------------- ----�- -------------- - ---------- - --- - -- ------- ------ - ------ -- --- FINAL INSPECTION BY:-_ ___ ______ _ Date___--- '_--1_ __. -__ _ SAN JOAQUIN LOCAL ALTH 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 Revises 1.57 F-P.CO.