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� S_,A PLICATION FOR SANI AT N PER IT Permit No.-- -3t �f (Complete in Duplicate) S� 4 � - - Date Issued *afions herebymade to + e S Joaquf Lal Health District for a permit to construct and s+all the work herein described. ion is made in compliance with County OrdmancL No. 549. JOB ADDRESS AND LO ION `' !! ------------------ ---- ------------------------------------------------ Owner's Name--------- ---- --f---_a- -- ------ ---------------------------------------------------------------------- Phone__ -� Address----------------- -w -- ----- --- - _ Contractor's Name___________________________ _-_ Phone--"? - _10(---------- ---------------------------------------------------------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: j---- Number of bedrooms ---P_ Number of baths I___ Lot size ---- 0_0�� -__ ------ Water Supply: Public system ❑ Community system ❑ Private Dep+h to Water Tableft. Character of soil to a depth of 3 feet: Sand ❑ Gravel E] Sandy oam E] Clay Loam L] Clay ❑ Adobe* Hardpan ❑ Previous Application Made: Yes* No E] New Construction: Yes F] No ( � TYPE OF INSTALLATION AND,,SPECIFICATIONS: �Q {No septic tank or cesspool permitted if public sewer is available within 200 feet.} Septic Tankk�:° e Distance from nearest well_________________Distance from foundation________________-_.Material____--------____--____________________________- � lj` /�•� No. of compartments------------- -------/--Size--------------------------------Liquid depth--------------------------Capacity----------------1 Disposal Fielc` Distance from nearest well __-._.D•istance from foundation----X__f_________Distance to nearest lot line__ --_-_. Number of lines---------- ---- ----W__----- Length of each line------_ - -- -----------Width of trench-----.c ------------------------ Type of filter ma+eria�+✓� -_-Depth of filter material----1.X-------------Total length___:_y _ _______________________ Seepage Pit: Distance to nearest well-----------------------Distance from foundation....................Distance to nearest lot line------------------ F1 Number of pits----------------------Lining material-----------------------Size: Diameter------------------------.Depth---------------__-••------------- Q Cesspool: Distance from nearest well-----------------Distance from foundation-------------------.Lining material------._-___--_________________-_____. ❑ Size: Diameter_-. Capacity gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building------------------------------------------ 0 Distance to nearest lot line-------------------- - ---- "------------------------------------------------------------ 4 r4l Remode ing or repair' (cd tribe):________ ,mss - '__ _ -- ------------t _--_------- ---- ` '� A:---------- .. �.,.:... dam.-- - - --------------------------- ________________________________________________________________________________________________________________________________________•-•________.._.____.____-_______________________---_______-_-__-________________-.- _____________________________________________________________________________•_-_-_.--__-___________-__-_.____-___.-_-_-___---.____________________________-._-___-___________.-__-_..-_-_-__-.____-___________________ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State law nd rules nd egulations of the San Joaquin Local Health District. (Signed) -------------- - ------------------------------------------------------------------ ----------------- Owner and o ontractor BY: -------------------- --------------- ------- ----------- Title _r [Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side} FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BlDATE_- ----------- REVIEWED BY---------------------- ----- ----- DATE BUILDING PERMIT ISSUED - � --------------------------------------- DATE------- V-- -------------------------------------------- Alterations and/or recommendations------------------------------------------------------------------------------------------------- -•------------------------------------------------------------- ---------------------------------------------------------------------_------ ------------------------------- -------------------------------------------------------•----------------- ---------------------------------------------------------------------------------------------------------------------------------------------------- ----------------------------=----------------------------------------------------------------------------------- -------------------------------------------------------------------------------------------------------• --- FINAL INSPECTION BY:........V0--- --_ --------------------------- Date---------- __� ' _ � R 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 E5---9-2M 8-51 Revised W-2100