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1,r l PLICATION FOR SANITATIQN .PERMIT Permit No. ..�� .Z 11 (Complete in Duplicate) )/ Date Issued Application is hereby made to the Sdn Joaquin Local Health District for a*permit to construct and install th This application is made in compliance with County Ordinance No. 9. a rk herein described. JOB ADDRESS AND LOCATION---- .- �C.------ -----------------------•----------. __ L4� ------! - )Fee _.._R�pl-p Owner's Name � J ryf y ................................ ------ -- - ---- Phoe................................... Address /" -f f9 s' C�4-A✓ Contractor's Name------------------- e C A/ V ------------- ------ ----------------------------------------------------------- Phone--•--•- Ins+aIle+ion will serve: Residence ❑ Apartment House Commercial , Trailer Court ❑ M el ❑ Other Number of living units: -------• Number of 6e4?eaf*6•=/-_ Number of baths ._ 690 sige Water Supply: Public system Community system ❑ Private ❑ . Depth to Water Table ..-_..._ ft. Character of soil to a depth of 3 feet: Sand E] Gravel F] Sandy Loam E] Clay Loam ❑ Clay ❑ AdobeX Hardpan 0 Previous Application Made: Yes ❑ NoA New Construction: Yes K No ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well_.--_--_-......Distance from foundation-_-�0_-...__..Materi I_..___._- �' No. of compartments- �---__•-----_Size.__/r2-- _�•K�quid depth__.-___.� _Capacity _ � . Disposal Field: Distance from nearest ell -.-� f Distance from foun tion....w....-_.Distance to nearest lot line..._ �1_ 94 Number of lines______________ _s(<1 Length of each lin _ "�;j" - --- Width of trench......... .. 'r Type of filter material- -- - --- --------Depth of filter material.....f --_' Total length--a-f-�__ Seepage ength-- _- 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--------------- ❑ Size: Diameter---------------------------------------Depth-- -----------------------------------------.-Liquid Capacity--.•-•-•- .-........gals. Privy: Distance from nearest well _::-_------Distance from nearest building ❑ Distanceto 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)-j.,017 ------•-- ------------------------------------------(Owner and/or Contractor) By:,/---'� ----- (Title) •. ------------------•---••--•••--- (Plot plan, showing size o lot, ocation of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY___----- DATE_._.--._. ... ............................................................... -- --- - - -------- f•- REVIEWED BY ---------------- DATE --------- BUILDING PERMIT ISSUED................. ...................................... DATE------------- ----------------- Alterations and/ • rec mendatiogs.< _--:---_". .. --- --------- ------ ..la. .--••- •---••---- -- ----- --- - - - ------ -------- -------- ----------------- FINAL INSPECTION BY------ --- ---- - - ---- ----- _ - Date--------- -- SAN JOAQUIN LOCAL ALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Streit Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M . Revised 1.57 F:P.CO.