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uPermit No. --- ------- ."=----- APPLICATION FOR_SAN ITATION PERMIT {Complete in Duphcate� r /ve " __ Date Issued 7 Application is hereby made o 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. �- ---_-- ------� L�-� ------ -•----- ------ JOB ADDRESS AND LOCACION__________________w___._____-_ -.-- Owner's Name--- =---'- s ' '------------L`-------�..J--'--------------------------- Phone. f _ Address -- r 'f �� = ---------•------------------------------------------------------------------------------------- ------ -------- -------- --- ,{ y Contractor's Name------------------------ f ' Z?fin ------- Phone i� -`- � �--- Installation will serve: :Residence`� Apartment House ❑ Commercial E] Trailer Court ❑ Motel E] Other El � ?..:a f Number of living units: __ '_ Number of bedrooms _ Number of baths_ _- Lot'size _____________ _-.-------------------- Water Supply: Public systemrCommunity system ❑ Private ❑ &pth to Water"Table ✓_ ft, Character of soil to a depth of 3 feet: Sand ❑ Gravel E] sandy Loam [IClay,.Laam~❑ Clay ❑ Adobe.11 Hardpan ❑ Previous Application Made: Yes ❑ Nor New Construction: Yes ❑I No 'FHA/VA �,Y e„s El No lFel TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) Septic Tanh: r Distance from nearest w SDizeance from fo(�undatian____________________Material_____ ___-_________________- !p --------'--------- . ,No. of Compartments Liquid depth-------------------- Capacity_-- 1 - 1 Distance from foundation--- Distance-to nearest of li�e_ Disposal Feld: Distance of I neSearest well , Y Lengtn of each line____— _(_'___-�-;__.Width of trench_��_�__ _________________ 4 __ ' Type of filtematerial___ �-; jk/c,.Depth of filter material____. __--[J______.____TOtal length___ ________________________________ •- � - icn_ �_�..__..Distance to nearest lot line -�.--- See a e Distance to nearest well'-'-) e#r refound 4 ati r�, -� � �� Number of pits._-.__�_ -------------Lining material- - -4�>�,�-__Srze:'�D_iometer------�--��-�-------Dept h-----^----- - --------------- ' f. Cesspool: Distance from nearest well__::______.__:._Distance fromfoundation___ _ ___ Lining material__.________________________________. ❑ Size: Diameter-- ----------------------;---------- Depth---------------------------- -------- ------,----- d Capacity--.. --------------------gals I �•, Privy: Distance from nearest well___.________________________________------_______Distance from nearest building-------------------------------------._____- Distance to'nearest lot line -- { _ `------------------------ ----------------------------------------- F] ------- -------------- ----`------ ---------------------------------------------••---------------------------------------------- Remodeling and/or repairing describe]:_______._._________________ _ - A � \�. - -----___________________________________________________---------------- ---------- ______,-_ __._._.. . . -___________________________________________ __._._____ 1 _I_ 1 - i + - --------------- ----- ---------------•-----------------------I------------ -------------------•---------------- - I hereby edify that:l haveipr pared this application and that the`work will be done in accordance with San Joaquin County ordinances, Sgat laws, arfd r.ul aZ regulation of the anJoaquin Local Health;District. ;% __s_3_______ �_____Owner and or Contractor( 9 )------ -- �. { a _ Title= = -��- -= (Plot plan, showing size of lot, location of system in,relation f wells, buildings, etc. can be placed on reverse side. I_ FOR DEPARTMENT USE ONLY ------ APPLICATION ACCEPTED BY_1------------------- ---- DATE----- ✓ REVIEWED BY_ = - - = ---- DATE ------ ----------------- BUILDING PERMIT ISSUED-------=---------------- bATE - Alterations and/or recom endations-------------- --------- � -- ., _____ _ --------------------------------- --------if- ------------------------------------------- ----------------------- I ---- --------------------------------------------- -------------------------------------------------- FINAL INSi'1 CT1ON BY:._ - --SAN JO QUIN LOCAL HEALTH DISTRICT 130 South American Street i 300 West Oak Street 132 Sycamore Street 814 North "C"'Scree+ Stockton, California Lodi, California Manteca, California Tracy, California ES--9-2M Revisea )_57 FP-CO,