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5 I rmit No. . ..._. v APPLICATION FOR SANITATI i3 Z` (Complete in D I ( P � Date Issued �,1-7'��5 Applica-ion is hereby made to the San Joaquin Local Health District for it to construct and install t�/1sr��bed. This application is made in compliance with County Ordinance N . 549. .11 v JOBADDRESS NDeO4A1,, --------------- --------------------------------------------------------------------------J------/----------- Owner's Name '` -------------------------- Phone �� L Address--- ---•--•-------- -- --- ------ -------------------------------------------------------------------------------------------------- Contractor's Name----------- --------- --- - ---�'----------------------------- Phone - ? . Installation will serve: Residence Apartment ouse F1Commercial E] Trailer Court E] Motel F] Other ❑ Number of living units: Number of bedrooms .2._ Number of baths /_-__ Lot size -------------------- Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table//-_4ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobjr Hardpan ❑ Previous Application Made: Yes ❑ NoNew Construction: Yes No E]TYP E OF INSTALLATION AND SPECIFICATIONS: �� `` (No septic tank or cesspool permitted if public sewer is available within 200 feet.) eptic k: Distance from nearest well_________________Distance from foundation--------------------Material------------------------------------------------- _, r No. of compartments--------------------------Size-------------------------------Liquid depth--------------------------Capacity---------------------- Disposal Fie Distance from nearest well_________________Distance from 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-._.--_-...__-__-..--_-._--_.•_--._--__--- See a e it: Distance to nearest weII L= :.___. Distance fr m fo dation.�..��.�........Distance to nearest lot line----- Jam..__..._ \ p Number of pits______......_____Lining material .Size: Diameter_ --...._________Depth---__�1?�_-__________________ Cesspool: Distance from nearest well.................Distance from foundation----------..-------Lining material-------------------________--___._._ 4 ❑ Size: Diameter: ------------------------------Depth----------------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building-------------..__.____._.-.-_._._..____._. ❑ Distance to nearest lot line-------------------------------------------------- ----- 01 Remodeling and/or repairing (describe):_.__ -rt--_ ,,� '. :•. _ ___-__ r ►� ------ ------ -----------•--------------•-•-----------•---------•-------------------------- -------- ---------- ---------------------------------------- ---------------- ---- � - --------------------------------------------------------------- ----------------------------------------- - r -----`-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County rdinances, St aws, a ruu>, and re ions of the San Joaquin Local Health District. ` (Signed)---- ---- = ------- "`t ------------- ------------------------- ----( wner and tractor) By:..........------- - ---------------------------------------------------------------------------------(Title)-----�reverse ------ -- ------ (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be p acide). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------ --------------------------------------------- � DATE----------- ,w----27--ss ------------ -- -- ----------------------------- DATE-----------.l.-------------------------- REVIEWEDBY.--------------------------------------------------------- ---------------------- ----------- ---------------------------- ----------------- BUILDING PERMIT ISSUED_____________ _-.___._ __ .-_ .-__ .___ -.._ DATE _-__ ._.-..---.._.. Alterati and/or r ommendatio sem ;. � f .---------- ¢ .--- ----- - -._.. s r auk. ,ma * . fid` _;, ----------------------- ------------------------------------------------------------------------- -------------------- ----------------------------------------------------------------------- -------------------------------------............ FINALINSPECTION 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