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- J �- Duplicate) Date SANITATION`PERM `- Permit No. _-.- /�. .___ (Complete in Dupli ..,.....T.. _ .y,. .- _. � atc issue -------------- M . _ Applicafion is hereby made to'the San Joaquin Local Health District for a permit to-con, ruct and ins#all the work herein described. This application is made in compliance with County.Ordinance No. 549. JOB ADDRESS AND LOCATION------ Owner's Name------ = = ------ -- GPrcI . = °--- ------ Phone__'1 Address------ Contractor's Name---- = ------ --------------------------- ------- - ------- Phone. _ Z la _ I Installation will serve: ;Residence [Apartment House❑ Commercial 0 Trailer-Court ❑ Motel ❑ Other ❑ s der of bedrooms __ _ Number of baths _/___ Lt size .___ .��__�-X_� ____________.- t Number of living units:--/ Num, Water Supply: Public system I�Comm unity.system ®'"`Private❑—Depth'to Water Table l- '- ft: , Character of soil to a de 'th of 3 feet:Sand Gravdl Sand Loam Cla lLo ar; Clay Adobe R � ❑ { ❑ Y' ❑ Y ❑ Y ❑ �iardpan ❑ Previous Application Made: Yes [] No [ New Corin#ruction: 2-INo ❑ _ 1,.., --i.TYPE OF INSTALLATION AND SPECIFICATIONS: ,t;! r (No septic tank or cesspool permitted if pul6lic sewer is..availa6le within 200 feet.) [ No. of com arfinents:___-;_�-- --- ------�ize-__=_:-._-may- _-- _ _ Li uid d4 M t�iaL_�--- i _ I '- rDista�� 'from foundation-- q Septic T Distance from nearest well____ q D_ _p , /�� Capacity___. i th_ - 4a- 1 �d i Disposal F Id: Distance from'nearest well_:..._____.-_Distance from foundation---- ----Distance to nearest lot line____.__________._ .. Number.of.lines----------- --------_�__ _ Length f,,,e�ach line--------75----i--------Width of trench------r _�/---•-----"----____-- - R Type of filter materiaFl__,S! _=:r p-h of fila@r"materiaL_____ .:' g -_ / g= Total length P ------ UY!c . _-_�i,nfante from fo ndation___= Distance to nearest lot lme____�_______ Number of its.- ; __,_______Lining maTeria l_"Siz iDiame�te,r--__.�� " --..Depth--_ ---------- Cesspool: -_______• I Seepage st. Distance to nearest ell_._ Cess ool: Distance from nearest wei '.. a, I______________�_;Distance from foundation-.---�---�'''--..Lining material_...__,_-.-._----__________.__._ .___.� � p , t .,r ' ❑ ,, F�-----------� --------------------- Liquid Capacity----------------------------gals. Size,: iometer_____________ E Privy- Distance from nearest well____________ __ _ __...-,_D.istance,fram nearest building ------------------------------ ---------- 9 [] line---- _--- --- --------------------------------------------------------- infante to'nearest of - Rerno'deling and/or-repairing (describe}:------------------------- --------•------------------ ' ------------------------------------------------------- --------------------------------------------•------------ ---•-------•------------..-..---•----------•---------•--------------------•--•---------------------- -------------------------------------------- -- I hereby certify that l 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 Joa uin Local Health District. (Signed)-----------------------�----- -- ----------------- - ran Contractor) -- - --- ---------- - -- By:._.. ------------ {Tile) -04 _= (Plot plan, showing size of lot, location of system inj,4lation to wells, buildings, etc., can be planed on reverse side). i # FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-- ------ ------ + - --------- --------- DATE-- gyp'-------._----- ,.- - ---------- REVIEWEDBY------------------------------- ------------ ---------- ----- --------------------------------- =-------------------- DATE---- ---------- BUILDING PERMIT ISSUED--------------------- --------------------------------------------- --------�---==------------------- DATE_------•-= Alterations and/or recommendations-----------=------------------- -------- ------- ------------------------------------------= ------------------------------•------------------------------ ---------- ------------------------------------------ 1. _ h --------- ---------------------•--------------------------------------------------------- FINAL INSPECTION BY:-.. .-- --- = Date_ "= �. ':_�' SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES--9--2M ; Revised W-2100