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APPLICATION FOR SANI7ATIOERMIT P'e'rmit No. _!�___o_____ _ (Complete in Duplicate) � L `] 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 No. 549, JOB ADDRESS AND LOCATION------- Owners Name-----------------------------------•-----62--4 Mw__f?ra Phone_- = T--•---- Address-------------........----------------------------- L —. ---------------- ---- AlContractor's Name s r. -� 1_fL - � ----- Phone----- =� -7--------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ' [❑ Motel ❑ Other ❑ Number of living units: __Number of bedrooms __7-_`Number of baths ---I-Lot size _ L7_�1�_ 0"______________________ Water Supply: Public system X Community system ❑ Private ❑ Depth to Water Table�Qft: Character of soil to a depth of 3 feet: Sand ❑ Graver❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe a Hardpan ❑ Previous Application Made: Yes ❑ No Z New Construction: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: / (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Sojtrtic Tank: Distance from nearest well-----------------Distance from foundation--------------------Material -_______________________________--_-_________. ��U-9 No. of compartments--------------------------Size--------------------------------Liquid depth-------------------------Capacity--•-------------------- sal Field, 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______________--__----______________-_____ Seepage Pit: Distance to neares well---1104r-'.---Distance fVm foundation__ --*.:.__...Distance to nearest lot line__>�-�_____-. Number of pits---)-------- g 9r`-'•Q- --- .713 1----------Depth__PRZ--------------------- ____-_Linin material _____�_ __ Size: Qiameter_ 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 ` r. Remodeling and/or repairing (describe):--------------------------------------------------------------------------------------------------------------------------------------------•----------- --------------------------------- ----- -------------------------------------------------------------------------------------------------------------------------------------------------•-------------------------------- I hereby certify that I have prepared this application and that the work will 6e done in accordance with San Joaquin County, ordinances, State laws;endrules and regulations of the San Joaquin Local Health Distric+. (Signed).XA 1 �' ----------------- - r Contractor) W B - ------------------- - Ti+le !'}q I [ " } -� ------ -------- ------------ [Plot p] n, show' g s xe of to+, loca+ion of ys+em in relation to wells, buildings, etc., can 6e placed on reverse side). / FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY- ----------------------------------------------------------------------- DATE REVIEWED BY -------------------------- -- DATE---- BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE------- Alterations and/or recommendations----------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ •--------••------------- 14— FINAL INSPECTION BY:------ - Date--.--- �/(a _Z •�-- SAN JOAQUIN LOCAL HEALTH DISTRICT 138 South American Street 300 West Oak Street 132 Sycamore Street 814 Noah "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES----9---2M 5-51 Revised W-2100