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APPLICATION FO,.,w_JANITATION PERMIT Permi No. ._ 4.fl_ . (Complete in Duplicate) T/J Date Issued ---- -------- --- 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 CounL Ordinance No. 549. •-------------------•----------------•-•--- JOB ADDRESS A}I�� LOCATION---��--?"-�...... -- - �--- `�•�-y---- ---�-+--- ------------------------ - J , I --- Phone s-3--- •� Owner's Name__.--- --- -- •--�'"�"_'•�`--'�'- --- ----------------------------------------------------------- -- ------- ------------------- Q.� .•�.,,,......••---------'I-------•----------'•----"'-----•------------ ------------'-•------'•------_ " ---------------- Address _____..._._ �M 3 �-��_-'�'�`'-----• •-------- ----- --Phone_=----- I� ---4774 Contractor's NameZ --- - i Installation will serve: Residence QellApartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ �^f Number of living units: __I..___ Number of bedrooms __Z. Number of.baths ._,_-- Lot size ___ k. A--------------------------- ----•-•-------•- Public system Community system ❑ Private ❑ Depth to Water Table`7�?-_ ft. - d - Water Supply. y Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay I—]- Adobe[131""Hardpan ❑F Previous Application Made: Yes ❑ No W New Construction: Yes M' 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-_, _ y __ ____----__Distance from foundation-------------------- No. of compartments------ -- ---------------Size--------------------------------Liquid depth.-------- --------- ----Capacity----_.::: -- - r. DisposField: Distance from nearest welL_______________Distance from foundation--------.-----------Distance to nearest lot line--------.___.___. Number of lines-----------------------------------Length of eaSline-----------------------.------.Width of trench------------------------------------ ____-Total length Type of filter material-------------------------Depth of filter material------_---- -:- -------•---------- ------ ------- Pit: to nearest lot 'ne__�_________ Seepage�Pit: Distance to nearest Wella. Distance from foundation__ _G_ \ ®/ ---- Number of pits-----A---------------Lining material_�A-�a: Size: Diameter . a�o ��-��n------ � Cesspbol Distance from nearest well-------_---------Distance from foundation-------.............Lining met erial------------------------------ _.______ ❑ Size: Diameter-------- ------------ - --------------- --------------------------- ti------Liquid Capacity-------••------------------gals. Depth . _ ; - • f �e~�b`u;ld Privy: " Distance from nearest well_._:._.._ .___-- ------------Distance from near ing'�: _�_____ .,:---.:--,---- ❑ Distance to nearest lot line------------------------- --- ------------------------- 7V ------------------ ._ - ---------- fr 7 V --yR.U .-- ....... ----- Remodeling and/or repairing (deseribe):---- ----- "_91-i y--------------------------Q-------U -T:-------------------------------------- ------- ---.-- ------•-------------------------------------------------------------------------------------•------••-----_- ------•---------•------------------------. ------- __._.------•--------•----------------. aa ------ --• ------ --- --- -----------------•--•---- J I hereby certify that 1-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. .. �` ___ __-_--_-___.(Owner and/or Contractor) (Signed ---------- -------------- ------------ ------------- ------------ ----------- - ------ --E� I (Title) ' [Plot plan, showing size• lot, location of system in relation to wells, buildings, etc., can be placed on revers side). /Z, FOR DEPARTMENT USE ONLY ' -- ------ DATEQ�---------- ------------------------------------------ APPLICATION ACCEPTED BY ---- ------------- -- -- -------------- --------------------- ------------------------------------------- _-------- DAT E__ ----------------------------------•--------------- REVIEWED BY-------------------- ----------- BU.ILDING PERMIT ISSUED.------------•-------------------------------------- -----------------------------•- DATE ^� Alterations a d ar recommendations:______q-.4 - - � ----------------- ---------- ------------------- - -- ------- -- -------------- -- -1............ -------------------------------------------------- ------------------------- --------- ----------T_� .......................__ _______.-------------_----- ------------------------------- ...� FINAL INSPECTION BY-------------------- ------- --------------• . Date----- .c+ •--------•----------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West 001 Street 132 Sycamore Street 614 North "C" Stteet Lodi, California Manteca, California Tracy, California Stockton. California - e5—s 145446 n-rw000