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5Appr1k A IgAi6N. `�OR SANITATION PERMITPermit No.(�omplete in Duplicate) Date Issued ---1 -tion is hereby made to the San Joaquin Loca alth District for a permit to construct and install the work herein described. This application is made in compliance with Coun r mance No. 549. r JOB ADDRESS LOCATION••• f------ --- --- -- -- ---------------------------------------------------------------------- Owner's Name----------•- -- ----- ------ -- ----- - .......................................... ------------------------------------------- Phone----------------------------------- Address--- t`` .----••------ - - ---- ----- .....----•----------- Contractor's Name -- •-• .......... -•--•--- -------------------=---------------•----------------------------------------------------------------------- Phone................................... Installation will serve: Residence// Apartment House ❑ Commercial ❑ Trailer Court [-] Motfl F1 Other Number of living units: _-L_- umber of bedrooms __1___ Number of baths __1___- Lot size =(/_n-----AX__12 _-____________-- Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table ________ ft. Character of soil to a depth of 3 feet: Sand Gravel ❑ Sandy Loam Clay Loam ❑ Clay ❑ Adobe�rclpan ❑ Previous Application Made: Yes ❑ No RNew Construction: Yes �o ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if ublic se r is available within 200 fee/et.)?�� Septic nk: Distance from nearest well. ista cp fr�IIfountion__1 _rT�71a#t i I_ ______________ No. of compartments___._ - _-___-_.__ ze_ C11__X_ ___Liquid *pth-_______ _______________Capaci4_1044�r Dispos Field: Distance from nearest w 11---- __ __ istance from foundation_/Q-- ... (stance to nearest lot lin Number of lines_________ _______L___ ____ _Length of each line........... ....Width of trench_ ----- -. __------------- Type of filter mater , 'f - "'�epth of filter material Total length Q--------------------- ---- Seepage Pit: Distance to nearest well-_--------------------Distance from foundation....................Distance to nearest lot line_..-._____--___-. ❑ Number of pits------ .--------.Lining..material......................._Size: Diameter---------- -- -----.__Depth --------_------------.--------. Cesspool: Distance from nearest well-----------------Distance from.foundation--------------------Lining material-------------------------.------------ El ______.__.❑ Size: Diameter--_---------------------------------Depth--------------------------------- - -----------Liquid Capacity _----- :-•--_Cja]5r Privy: Distance from nearest well________ ___-___________--------------------Distance from nearest building________------------------------ - ❑ Distance to nearest lot line______________________________ Remodeling and/or repairing (describe):-------------------------------------- ---•-------------------------•--------------------------- ........................................................ ---------•--•-----•---------------------•-•------•--------------------------------------•-----------------•--------------------------------------------------------•-----------------------•----------------------------••--- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed)..,g n --- • •-•-._,a. r !_E"'t— ----- --- - ------ ----------------------------------- --------- -----------(Owner and/or Contractor) By:.------- --------------------------------------------------------------------------------------------------------•(Title)---------------------------------------------------------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED B -- -••----=--------- ----------------------------•----•---. -•-------•••-•---•---••----•------ DATES-------------------------------------------------- - REVIEWED BY------------ -- --- DATE BUILDING PERMIT ISSUED................... --------------------------------------------------------------------------------- DATE-- ----• - Alterationsand/or recommendations--------------------------------•--- -------- ...............................................................1V........................................... ------ -- ------ ---- -----•------- ----.-- ... ------------------------------------------------------------ -- -----------........................ - � ----- FINAL INSPECTION BY:----- ----- k ---- ------ Date----•- r j-- ------------------------------------------------- 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 10-52 Revised W-2100