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�.�.^'.".' --- ^moi •:-h1'�.. - � ° �-�APPLICATIQN _FOR SANITATIQN PERMIT Permit N6. ' 9r.S�7 (Complete in Duplicate) _. Date Issued,+_y!_- 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. _. v - JOB ADDRESS AND CATION— --=9,----_ Owner's Name ------ �'� ----------------------------------- ---------••----------- --------•------------ t Address Phone ----------------• Contractor's Name----- E-" -__-_ 6 ----------1 Phone - C��D Installation will serve: Residence Apartment House ❑ Commercial { ❑ Trader Court ❑-�Motei ❑ Other ❑ Number of living units: _ 1-_ Number of bedrooms _�-- Number of baths Lot size _�� ` t a-.X� a Water Supply: Publics stem' Communit s stem w 4 _, -- - ----------------------------------- pp Y' Y � Y Y ❑ Private ❑ Depth Water Table-��_'ft. t Character of soil to a depth o0 feet: Sand nd ❑ Gravel ❑ Sandy Loam ❑ C'lay Loam ❑ Clay ❑ Adobe an p Hard Previous Application Made: Yes ❑ No � New Construction: Yes [INo Elr. TYPE OF INSTALLATION AN SPEC IFlCATIONS:t i (No septic tank or cesspool permitted if ublic sewer is available within 20 feet.) hit �•� ,. Septic Tank: Distance from nearest w•eli_- - - #Distance from foundation- ®-------_-_.materialj_ E__ �_-_---•--.--"-_-- : „_ ® No. of compartments"--o2.. ---- Size----`-5./-X3_4---------Liquid depth----yrr Capacity--94-6 e f Disposal Field: Distance fr`gm nearest: well-14w--)-_Distance from foundation, __�-_----•Disf�nce{to nearest lot line--- �--- I$ Nu`snber oiGnes------- -__. Length of each line_----- - --D`----_-_-Width of trench.---,o --___ 1 ------------ Type of filter material-- - -------.Depth of filter material-- "'�-----Tofa'I length__.---_-. G-_�_._- -----•--------- Number of4nearest wel,._-- Z` p i ) i -. � '/----"Detente om oundation... ."---__.•.- Distance to nearest lot line---------------- Size: --__._----- Seepage Pit: Distance foPifs / Lining material-- " `r i Size:+#Diameter . Depth_-_.c ` Cesspool: Distance from nearest{ well_______________ pistance from foundation. ---,-.-----`----. ' ! Lining material---=---=----------------------------- \\ ❑ 5ae: Diameter------------I------------------------ Depth ---------------� Liguid Capacity...._' - gals. \. Privy: Distance from nearest! piste-n��e fro nearest buildin ❑ Distance to nearest lot line---------_'----- r, g----------------------------------------. r - ------------------------ --------� = ------ Remodeling and/or repairing (describeI- ------- ---------------------------------•----------•------•------------• # .. -------I------------------------••---------=•-----•---- ----- ----•---------- ------------- PIK ! ----------------••------•-------- y` ------------- �'--------•--------4------- --- --_-------"--•-_--•-------_-.._- "--•_ I`hereby certify tha+ I have prepared this application and that the work will-beNdone in accordance with San Joaquin County ordinances, to laws, and r les and regulations of the. San Joaquin Local Health District. F (Signed)------ -' ►�`-'�. - - --=---- ------- ---•`----•----------` Owner and/or Contractor) By: --------------- ' .. r Y, — ----------.,•------- ---(Title); (plot plan, showing size of lot, location of system jp-relatio o wells, buildings, `etc.; can be* lace on,reverse side). :a FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-'--------------------=- -- ---r- DAT�n------- REVIEWED BY_`------------- . �--- ------ - -- - - -- ----- --- DATE BUILDING PERMIT ISSUED------ =` DATE L--••----------•--=------•------ ------------------------------ - Alterations and/or recommendations-------------- (i E ------------- --------------------------------------------------------- -------------------------- .-------------------- ------------- i r '9 ---------•--- ------------- ---------------- it : I i -------------------------------------------------------------- FINAL INSPECTION BY:. -_. ..... . Date ---- . - f7--------------------------- SAN JOAQUIN L CAL HEALTH DISTRICT I 130 South American Street d300 West Oak Street 132 Sycamore Scree} 814 North "C" S}teat Stockton, Californiaa Lodi, California Manteca, California Tracy, California ES-9-2M Revised W-2100