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CY •• 15 "L !�'� 4 ,,(Complete FOR SANITATION'-PERM_ 1T,:r, Permit No. _-• !� Complete in Duplicate) ti f t �\7 Date Issued 1 ' Applica+ion is hereby made to the San Joaquin Local Health District for a per to c-onstruet and instaill the work herein described. This application is made in compliance with!County Ordina No. 549. ` JOB ------ADDRESS A O IC N - -------- --- - -- ---------------------------------------•-----------------•------------------- Owner's Name__ . '........ -------" = Phone f Address--------------_ - -- ---:--•-•---------^•----------------------------------------------- Contractor's. Name---------------------------- -------------------------=- - -•--------- •---------------------------- Phone. . - i -Installation will serve: Residence Apartment House ❑ Commercial ❑,+Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _. ____- N umber of bedrooms' Number of baths __1___ Lot size ' ./� ____________________________ Water Supply: Public system Community system ❑ Prixate ❑ Depth to Wafer TableQft. I I. 'Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑' Adobe Hardpan ❑ Previous Application Made: Yes ❑ No New Construction: Yes No ❑ e!YPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) -eptic Ta Distance from nearest well-----------------Distance from foundation--------------------Material:---.-------__-.----_-_-------__---___._-.___._.. No. of compartments--------------------------Size --------------------------------Liquid depth------------ -- --.Capacity------------------- isposai Fi Distance from nearest welf----- 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_-__-_-_----__:---__-_--_-------_---_--_--- 6 i Seepa e Pit. Distance to nearest well__ __Distance f m fo dation_ _____._..Disiance'.to nearest hot ' Number of pits.___/-----.--__'.___.Lining materia'.. Size: Qiameter____ --------- -._.-Depth____ ----------,( i Cesspool: Distance from nearest well-----------------Distance from foundation-------------------- material-______.-.___..----..-.--__--__-----. ❑ Size: Diameter---------------------- --- -----------Depth--------------------------- --- ------Liquid Capacity----•------------ -------.g ahs. - --- N Priv Distance. ,rom nearest well__________ _ ______ . ._____._._.___-..-__--__-_.___Distante from nearest building------------- ----------------------- r Distance to nearest lot;44 ----------------------------------------- - ---------- -------------------------------------- ------------------------------- Remodeling ------ .------------------ I Remodeling and r repairing (describe):_-__ f _ _ _ .___ __--------------- r `---------------------^------------------- -- -- -------------------- . - -- ----- _ `*'__ '----------------•-------------•----.........__.-'----------.•--._...._..»._.......»._-----•---•------- _________ -------------________________________________________________________________________________________________________.__________ - I ----------------------------------------------------------___-.-____-_______ hereby certify that I h prepared this application and that the work will be done in accordance with San Joaquin Coua#y:. of finances, Stat A and es nd regulations of the San Joaquin Local Health District. (Signed)--------- ____ _________ - _ caner and/or Contractor) --------------------------------- 13 - {Title): - ---------------------------------- I Y- ----- --- --- --- -- (Piot plan, showing size of lot, loc tion of system in relation to wells, buildings, etc., can be pla d o � arse side). FOR DEPARTMENT USE ONLY f APPLICATION ACCEPTED BY------------ ----- DATE- ;;---------------- BY-------------------------------------------- -------- - ----------------- ;-----------------------------------------. L7ATE ----------------------------------- REVIEWED , BUILDING PERMIT ISSUED------------------------------------�.-- -- DATE----------- ------ -- ----------------------------------- Alterations and/or recommendations--- ------ ----- ----------- -- --- - `, ---_--._._---- -------- - ----------- ------------------ r ----------=--=-=---- ----- -------- ----- . . �r6 cn � ------- ----------------------- ; Q! v --------------- — �... ti v -�-�s------ ------ --------------------- . a.f G FINAL INSPECTION BY:.-- -------- Date: l`y i 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-9-21M : Revised W-2100'