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U AF CATION FOR SANITATION ✓ � ry PERK Permit No.�__�1--- �j � � (Complete in Duplicate) � T Date Issued . Thi Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. s application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION.._--��_I-�__� j- J ----- 0V_Cdj0-R_A�Z-------- Owner's Name----------------- * ` i5---------------- - - Phone- - " Address---------•-------- ----•-----------•---------•------ Contractor's Name____ __________ --Q3 --------------•--------• ------------------------ - ---•- ;� --— ------------------------------------------------------------------- Phone---- -- - -C Installation will serve: Residence W Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other El Number of living units: _--k Number of bedrooms '�+_. Number of baths .--L Lot size .--��"�_yC ��-d--'---- Water Supply: Public system 00 Community system ❑ Private ❑ Depth to Water Table .5 ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel [] Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe K Hardpan ❑ Previous Application Made: Yes ❑ No LW New Construction: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: t (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Y . ptic dank- Distance from nearest wellDistance from foundation-------------------.Material-- _--__-.-.____.___._ _ "]!�� No. of compartments----- ---- ------ Size_ -------- ---------- W Liquid depth Capacityosal 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 nearest well-AfJK4------Distance� fro foun ation-./_-0.__-____-_-,Distance to nearest lot line_--Number of pits-------/-------------Lining materiaiA01tSize: Diameter---- rP p , % _' r ------- Cesspool: Distance from nearest well____------" --Distance from foundation--------------------Lining material-----------------------------------------------Sire: Diameter --------------------- -------Depth-----------•----------------- ---------------------Liquid Capacity-....----•---- ----•-'=��--gals. Privy: Distance from nearest well-----------------------------------------_ Distance from nearest building Distance to nearest lot line--------------------------------------------- Remodeling and/or repairing (describe)_______ _____ -------------- ------•---•------------------------•--- -------------------- ------------------------------- --- --------------------------------------------------------- --------------------- ------ ----- ------------------•- - ------ -- 1— ---•----- - ------ --•---------------- i I hereby ce ify that I have repared is application and that'the work will be done in accordance with San Joaquin County ordinances, r a s, and cul and regul tions of tie' n Joaquin Lacal 0ealth District. (Signed)--------- - -- - ----�- �- ------------------------------------------ � ---�---- ------- -------- - ----------------------------------------- By-_-------•------ -Contractor) ----- r Co or) . --------------)Title) cl�,rs. �+s�J -. (Plot plan, showing size of lot, location of cyst m in rely ' to IIs, build' gs, etc., can be pla ed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---- --- - -- --- ------------------------------------------------------=----------------- DATE------ ]? REVIEWED BY-- ------------------------------ ----- --- -------------- --- --------- --- --------- ----------- -------- ------------ - -------- DATE-----------•--- -------•-- BUILDING PERMIT ISSUED---------------------------------------------------------------------------------------------------------------- --------------------------------- ---------------------------------. DATE..--------- ----------------- - - AI#erations and/or recommendations:---.--.___"_._ --------------- FINAL INSPECTION BY: ______________ _ 3 -------------------- Date SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street y 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M 10-52 Revised W-2100