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V9 APPLICATION FOk.�__ANITATION PERMIT- Permit No. _7410.f... (Complete in Duplicatel 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 County Ordinance No. JOB ADDRESS AND O ATION_-__._-_---�/ - - __ __ Phone Owner's Name Address..---- -- -_-----------------••------------------- ------------------------------------------ Contractor's Name------------- ----- -- --------------- ----- ------------ Phone---------- Installation will serve: Residence Apartment House E] Commercial El Trailer Court El, 'Motel ❑ Other E]Number of living units: Number of bedrooms_ Number of baths o __ Lot size ,/�Q- t r ----= - -• ---------------------- Water Supply: Public system Community system ❑ Private ❑ Depth to Water Tabled ff. f Character of soil to a depth of 3 feet: Sand Gravel A r ❑ ❑- Sandy Loam [] Clay Loam❑ Clay ❑ Ado b Hardlian ❑ Previous Application Made: Yes ❑ I'NOX New Construction: Yes No ❑ 3 TYPE OF INSTALLATION AND"SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) i Septic T Distance from nearest we -- Distance from foundation--------------------Material-____._- _..__._..____-""____..__y. _._______. No: of compartments Size Liquid depth_ - --------Capacity-•--------------------- isposa F' d: — Distance from nearest well-'_------------__Distance from foundation---____-----_. _.Distance to nearest lot line----------------- Number,of lines------------------ ---------------Length of each line-------------------------- .Width of trench-__. 4 € Type.of filtermateiial--- ---------Depth of filter material----------- t------Total length----------------------------------------' See a e it: Distance to nearest well_ �J� - -� ° " ,. ____Distance fr .fou -tion.-__ f!_.. .__.Distance to nearest lot line ._ -; Number of pits----- _-:_—Lining material_ - Size: iometer_: Det "--- ._ c4sol: Distance from nearest we l-"---------------Distance from foundation_______---_--------.Lining material--_-___-..______--_._- --:_. [ ------ ❑., S+ze: Diameter------------------- `------------De th------------------------- - � Depth --------.Liquid Capacity-.--•:-------•---------------gals. -J Privy:- ' Distance from nearest well',`"-.'____________ _ .__Distance from nearest building------------------------------------------ 6 iDistance to nearest lot line_-`"�.-- '� ---------------------------- Remodeling an /or repairing (describ`): --------'�'�I!" i -•--- .00� ....... -------•- ----------------------- = ----------------------- :---- :..----------------------------------------- -;---------------.--------------------- 3 -- -- -------- - ------------------------- ------ ---------- ----------- ---------------------- -----------------------------------------------------------------------------------•----------------•----------------------- I hereby c ify that 16 e prepared this ap ation and that the work will be done in accordance with San Joaquin Co' ordinances, Sta aws, and le nd 'regulations of'fhe San Joaquin Local Health District. y (Signed)•---- - -- --------' ------------------------------------------------ Owner and/orControct orl !� '.gy----------------•------- -�- --•-r•�-'--------••------ ----------------------------------------------=-----------------(Tifle)------- (Plot plan, showing size bf lot, locafion`of system in relafion to wells, buildings, etc., can"be pl ed on verse side). ( FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY__'�. .-......... : --------------•---------------- DATE-:!:::7REVIEWED BY------------------------------------ ----- -------------------- ----------------------------------------------------------- DATE---Y - = BUILDINGPERMIT ISSUED------------•------------------------------------------------------------------------------ ---------: DATE------ . t3-----------•------------------------------- Alterations and/or recommendations:___f_____________a- - --.-, — - "a...�.... . _... ---------------------------------------------------•------------_..--------•----------- --- I I: ________________________ ____________________:.y_____..._ ----_-___---------____----_ ------------------------------------------------------------------------------- .-------------------------------------------------------------- _-__--_--"--------------------------"----------•-_._-----..--------- { FINAL INSPECTION BY:------- ` Date----------------- SAN ---------- --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--4-2M Revised W-2)00