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\ APPLICATION Fd'1SANITATION PERMIT Permit No. _ [Complet®Cin Duplicate] Date Issued _______ 3 _ Applica-�ion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. is application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION3 --------------------------------------------------------------------------------------- M Owners Name----- ft__A--------------------`----- _------a----------i-" ----------------- -------------------------------- Phone__4i0-.-� Address_....�1 tz'-----r--- --- •--------------------------------------------------------------------------------------------------•------------------------------------------------ Contractors Name______: �___ - Phone. cf�-4 3�/. sem Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel (] Other ❑ Number of living units: ___I____ Number of bedrooms 24. Number of baths _>t_____ Lot size ._- _Q_____14____L _d___________________________ Water Supply: Public system ommunity system ❑ Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ ' Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe a--Hardpan ❑ Previous Application Made: Yes ❑ No New Construction: Yes <o ❑ 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-________________Distance from foundation--------------------Material-.-__--_--------______-_____________--___--_____- c No. of compartments-=- -- -------------------Size------•-----:-------------------Liquid depth--------------------------Capacity----------------------- D posal Fiel : Distance from nearest well_---------------Distance from foundation---------------------Distance to nearest lot line----------------- , ❑ Number of lines-----------------------------------Length of each line-----------.------------------Width of trench------------------------------------- � Type of filter material______________ ________Depth of filter 'Material-----------------------Total length_-____.--._---_________________________: Seepage Pit: Distance to nearest well___4.q-----------Distance from foundation___J_f1---------Distance to nearest lot line----1_{,__----_ �6 Number,of pits---1-_. --------------Lining material.U- c�. __-----Size: Diameter------.-----------.Depth------3d------------------- Cesspool: Distance from nearest well-----------------Distance from foundation--..----------------Lining material__.__________-___--.---._'_-____----_ Li uid Capacity gals..❑o Size: Diameter--------------------------------------De th_.______------- -----------------_------------------- Distance --- --------- Distance from nearest well -------Distance from nearest building_._______-.__-________________.___.___._.rvy: ].t i ❑ Distance to nearest lot line-------------- -------------------------------------------------------------------- ------------------------- i Remodeling and repairing [describe= 31 '�'�-d ..- �— +� --------------------------------------•-----•----.•--------•--•----,-----------•---------------------- i . •---------------- ------------------------------------------ :.. i i r }� -------------- ------------------------------------- -------------------------------------------------------------------------•----------------------------------------------------------------------------------------------- i I:hereby certify that I 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. , (Signed) -------------- ------------------------t--------- ----------------------------------------------------------------------Owner and/or Contractor) BY= _... - ------------------------------------------------------- Title] �`' "''` "'`'*, ` (plot plan, showing�siz0of lot, Iota+ion 6f system in relation to wells, buildings, etc., can be placed on reverse side).i i ? FOR DEPARTMENT USE ONLY t APPLICATIONACCEPTED BY--------------------------------------------------I-----------------------------------•----------- DATE------------------------------------------------------------ REVIEWEDBY-------- ------------------ - -- ---------------------------------- DATE--------- ` BUILDING PERMIT ISSUED- .� _,.. - ------------------ ------ DATE----- - - Alterations and/or recommendations------------------------------------------------------------------------------------------------- " ' t -------- --------------------------------------------------------- •----------- ------ ------------------------------------------------------ --------------------- ---------------------------------------- --------------------=----------------------------------•-------- ...---------------------•-----•-------------•----------------------------------•--------------------•-- -------------------- ---------------------------------------------;-----'------- ---------------------------------------------------------------- --•--- ----_----- i --------------------------- FINAL / ---- Date.-----------I---�- ��:'� INSPECTION BY: e - ------------ SAN JOAQUIN LOCAL HEALTH DISTRICT i -, 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street T Stockton, California Lodi, California Manteca, California Tracy,'California /S-9-2M ; Revised W-2100 / Axa