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r APPLICATION FOR SANITA''ION PERMIT 4mit No. t��l � `��, (Complete in Duplicate) aP/� P C�� e Date Issued .!`__'�_ � � d gg Application is hereby made to the San Joaquin Local Health District for a permit to construct bn� install the work herein described. This application is made in compliance with County Ordinan o. 549 Q� 2 JOB ADDRESS AND OCATION_.....�. p,J---- ------G---' � Owners Name /M- �1 -------------/ A....----Rt--------- -t�WW41_M-----------__ ------- Phone.._............................ Address.. " -- Contractor's Name I -- -� R Phone - &.e -..... 1 Installation will serve: Residence "A" Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other Number of living units:(51--V-Number of bedrooms —Number of baths/------ Lot size __x.._ I�� -- Water Supply: Public system X Community. system ❑ Private ❑ Depth to Water Table Y,Q__ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑` Clay❑ Adobe Hardpan ❑. Previous Application Made: Yes ❑ NotZ, New Construction: Yes E] No ($� TYPE OF INSTALLATION AND SPECIFICATIONS: r (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank:. Distance from nearest well__YjP.d.4Z,___'Distance from l!foundation I t M`teria� _l �t.-�'_�-� No. of compartments_-__ .______-Size &::! 3fv___Z.PkLiquid depth..._-______-___-•-Capacity-__!�� Disposal Field: Distance from nearest well IVR °_Distance from foundation s�� Distance to nearest lot line " Q . -.r Length of each line__ Q ' Width of trench i Number of lines.__ _ _ _ Type of filter materiall/X$,'__ C�Depth of filter material__.... ....Total length-------„ZQ 'r..__..:. -_-...-_ Seepage Pit: Distance to nearestw -Nr_!11 __-_Distance fr fou ation_. �__--..Distance to nearest to line Number of pits- !11 --Lining material.-.. . lize: Diameter--------------.Depth--- -f--------- -------- Cesspool: Distance from nearest well................Distance from foundation--------------------Lining material----------_----------------------- aterial _-_._.--- _•-__---.•-•-_--•- ❑ Size: Diameter---- ------------- Depth--------------------------------- - . Liquid Capacity---------------------_------ gals. M Privy: Distance from nearest well___•- _________ ____-__.--_--___________Distance from nearest building__..__ ...._____ ........- _,..__... ElDistance to nearest lot line------- --------------------------------------------------------------------------...................................................... Remodeling and/or repairing (describe) ,------- ____ - ------------ ----------------------••---------- -------- ------- --- ---- --•----- - . -----••• ---.._..-•---------•-----•----•------•-••------------•--. --•---• ------ ---•-•. ------------------- ------------------ ------ ............................................... I hereby certify that I have prep d this application and that the work will be done in accordance with San Joaquin County; ordinances, St a laws, and rules an re ulations of the S "Joaquin Local Health District. (Signed)---- --•---- ---8-----�-� ---y----------- -----� -- '-- -------' - ----------- --- ------ ------ ----- ----- �-{OrrnA�anr Contractor) BY: - _ C. ------(Title)-- (Plot plan, showing size lot, location of system in relation to w Is, buildings, etc., can be plat on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY 1/, / DATE-- --- - - j"'---- REVIEWED BY- --------- -------- -------- ----- ----- --- [---- - ------- ----------------- ----- DATE v BUILDING PERMIT ISSUED-------------- --------- ----- - ------ ------ -- _--------------- DATE- Alterations and/or recommendations:----------------------------- ---- •-------------------------- ------------------------------- ............................. - - ------------ -- ------------- -- -- - --- ------- ------- --• - -------- -------- FINAL INSPECTION BY:---- -`" -- -------- -- •- Date-------- --- --- --- ------------------------- SAN - - -----SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North"C",Streef Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M 8-51 Revised W-2100