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7y FLIGATION FOR SANIT - �` - Permit No. ___--- rx" (Complete in Duplicate) S_7 _ y r - V Date Issued Applicatiofi 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 Cou�ntty Ordinance No. 549. s JOB ADDRESS AND LOCATION-- !0...�,_ y ------- ------R-3........ ----- Owner's Name C/O/. --_ .._hY_�. _v 3- ----- -------- Phone..---f._51-4-- ... Address ......-....V 4-X-------S-3--I---------------------S-r----------------------------------------------------------------- ..................................... Contractor's Name._> ---------- ...... ------• -------r .. -'-------••-_-- Phone-- '- ---4A.- Installation wit aervez 'Residence (I Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ;Y Number of living units: _._1_ Number of bedrooms _y-_• Number of baths ---A- Lot size _...L ._�r �__x__-_ it 04_.__.____ Water Supply: Public system ❑ Community system ❑ Private [A Depth to WaterTable .-_..._ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe(I Hardpan Previous Application Made: Yes ❑ No [;j New Construction: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: Se tic Tank septic'tank or cesspool permitted if public sewer is available within 200 feet.) p Distance from nearest well S�Q _Distance from foundation......I --__.MatenG al______ C......6P C [� No. of compartments___ __-.____-._-_--_ depth...... -_-a-----------Capacity-A00_fl� A Disposal Field: Distance from nearest well---------.--------Distance from foundation--------------------Distance to nearest lot line................ Number of lines................-................-Length of each line-------------------------------Width of trench----------------------------------- Type _---__ ___-__-------__-_Type of filter material-___ -----------------Depth of filter material :_,.__-----------Total length----------------------------------------- Seepage _•_---. _..__-_.- __-____--•-- Seepage Pit: Distance to nearest well----------_----------Distance from foundation--------------------Distance to nearest lot line............. ._.. ❑ Number of pits----------------------Lining material-----------------------Size: Diameter---_ -___.-------.--Depth--------------------------------- Cesspool: ----------------__-- -------- 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---------........._---------------. ❑ Distance to nearest lot line------- ---- -------------------------------------------------------------- ------ Remodeling and/or repairing (describe):...........................................-- ------------------ -------- ---------- - -•---•------.---- ---- -- ---------------.-•---- ----------------------• -••••-• ••-- •--•--••---•--• -------- -------- -------------------- ----------•-•---------- --•----- ------- --------------------- -------- ------- --------- I 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. j} - � --�-•• ., � Contractor (Signed)..----./.� - ... ..Vr a - �� +"d1�a ) ... s -- ----- --- ---- Title ------•---•----- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY - - • -- ----------------------------------------------- DATE--------------•-------•-- ------------------------ REVIEWED BY.............................--- % ---- -- -- DATE . -�__. BUILDING PERMIT ISSUED•------------------------ DATE Alterations and/or recommendations------------------- ----- ----------•--------------------------------. --------•------ . . -----•---••--•••-•--•-----------------•••--- FINAL INSPECTION ------------- Date-.--------- l `L S 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 8-51 Revised W-2100