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APPLICATION .IOR SANITATION PERMIT Permit No. + 1. --- (Complete in Duplicate) Date Issued _.-— !---- e Applica+ion 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._JO 7------ �.l � ;l------- ----------------- ------------- -------------------------------------•-----------•---- I �. -C-- `rl9...... ----- -------------- - -----------------------= --------------- Phone__1�0i_`.�_-"-��1 Owners Name.----------_--��-•---�'---- ------------------------ _ --------------- -------------------------- �,� ... - 1 Address-------- - A - -------------------•-----------------•------ Contractor's Name--------•-d - _N--- Phone-.----- ---------------- Installation will serve: Residence ® Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: --r Number of bedrooms -T,__ Number of baths Lot size _____---- -------------------------------------------- Water Supply: Public system �L; Community system ❑ Private ❑ . Depth to Water Table Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay X Adobe❑ Hardpan ❑ Previous Application Made: Yes.E] -No tA New Construction: Yes bq No ❑ i TYPE OF INSTALLATION AND SPECIFICATIONS: r (No septic tank'or cesspool permitted if public sewer is available within 200 feet.) x Septic Tank: Distance from nearest well------------------Distance from foundation-------------------.Material-------------------------------------------------- ❑ No. of compartments---------- ---------------Size----- ----------------------: Liquid depth Capacity nearest well_________________Distance from foundation________________.__Disfiance to nearest lot line----------------- Disposal Field: Distance from ❑ Number of lines----------------------------------Length of each line--------------------- --------Width of trench--.-------------------------------- ,'} Type of filter material-----------------------,Depth of filter material--------------------hTotal length--:- -------------------------------- w Seepage Pit: Distance to nearest well-----------------'L-Distance from foundation-------------._._:-.Distance to nearest lot line----------------- M ________________ G .Size: Diameter------------- Depth--------------------------------- i ❑ Number of pits ---------------Lining material ; Cesspool: Distance from�ne rest well---_.^= Distance from f oundation._I. '___ Lini n5aterial__R��Q-_--------- Size: Diameter_ x-5- ---- -----------Depth-- � Liqui apaci{y, -_ _ gals. . P ...... - . ,�Y., . Distance from nearest well------------- ---- -- - ---- -------- tante from nearest uilding--- - -- ---------------:__ _-:1 Distance to nearest lot line----------------- --------------------------------------------------- --._ ------------ ------------ - '- ' Remodeling and/or rewiring (descriE�e�:: z - d �` ------------- --------------------------------- 'a----- -------- O w. _____________________________________________________________ __________________________________________________________�-_.__R..______. - i -_________..___ ___ _____________________________________________________________4_.- -------------------------- ______ __ _____-__-.-t------ ----__:_______.____._-...____ 1 hereby certify that I have prepared this appli tion and that the work will be done i h`'Sart Joaquin County ordinances, Stat laws, and rules and regulations of he Sen,4oaquin Local Health District. w; + (Signed)--____ = ._. -(Owner and/or Contractor) ------ --- ----- "----- Title (Plot pian, showing size of lot, location of system in re ation to wells, buildings, etc., can be placed-on reverse side). I _ FOR-DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------------------------------- -----•------------------------------ DATE t`- � o --------------- REVIEWEDBY------------------------------- - --------------------------------------- DATE-------------------- ----------------=•------------------- BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE------------------------------------------------------- Alterations and/or recommendations:-------------------- = •--- - ---- •----- ---- : --------- -- -- ---- ---- --- --- - -------- FINAL -INSPECTION BY:;.--- ------------------------------------- Date "d SAN`JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 Was* Oak Street 132 Sycamore Street 814 North "C" S+roe+ -- Stockton, California Lodi, California L Manteca, California Tracy, California ES-9-2M ; . Reviser! W-2100