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APPLICATiON FO.Y �iANITATION PERMIT Permit No. .___`�_3..9 _ 1n Duplicate) J (Complete P. Date Issued .-.-- Application Application is hereby made to the San�'Joaquin Local Health. District for permit to const uct and install the work herein described. This application is made in compliance with County-Ordinance No. 549. " JOB ADDRESS AND LOCATION---Z_6_,6_q- - ------------•------ --------- --------------------- Owner's>I lam 1.;��_ -------------•-_. ---_--------- ---------------------------------- . ._: Phone ------------------- ---- r a --- r r �•�-'-----------•---�----i-• ' `__•_ 'k,. - � ,}•••-t"1-DC7 Addressi yS. _ •--------- ------------------------------------------------� --•- -- -�, i - __ Phone ContractorsName------�._�" �;:,=•--__�_'�_��--------------------- ----------------------------- - ------------------------------------------- -- Installation will serve: Residence [Apartment House ❑ Commercial ❑ (Trailer Court ❑ M f 1 ❑ Other El. +. , � Number of living units': ___�___ Number of bedrooms :_T____ Number of bath`s ---J--- Lot size ___ -- �____. -/dam----------------------------- Water Supply: Public system Community system El Private [j 'Depth'to'Water Table_-, ft. Character of soil to a depth of 3 feet:, Sand ❑ Gravel ❑ Sandy Loam{El . Ciay Loam ❑ Clay ❑ Adobe ®Hardpan ❑ Previous Application Made: Yes ❑ No 5" New Construction: Yes 0- 'No ❑ PHA%VA: Yes ❑ No R- 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_________________Distan e f om fo Anda ion__:1Q____________-Material___ _ _.___:_____�__�______ -.-_.. , � iNo_ of compartments-------F^_______________5ize__-._��• __-- -- ;Liquid de ---.....capacity---- --------- - Number of lines_______�____�-_,--__.______._��Leri th. of each line_____��_____---- -••---Distance to nearest lot line_______.______._ k Disposal Field: Distance from nearest well---------------- Distaance from foundation '----- Width oftrench____________________________ ___ Type of filter material--------------------------Depth, of filter material------------------------Total length------------------------------------------ Seepa a Pit: Distance.to nearest well_ _ ___.,Distance fro�mfoundSize: ZiE`' € s .., r b on____.._ . Distance to nearest lot l',e___'s-________- Number of pits_-----s--------------Lining material__ e: Diameter____.7TS6j_______.Depth---------- ------ f -- Cesspool: Distance from neo estiwelL:____-_____-_Distance from foundation--------------------Lining material--------------------------------------- ElSize: Diameter------ i =' --- IDepth-----------------=-------------f--- I-----Liquid Capacity----------------------------gals. Privy: Distance from nearest well______________: ----------------------- -----._Distance from nearest building------------------------------------------ w-L ❑ ��..�.. __--.. . -Distance to nearest lot-lire" _- __-' Remodeling and/or repairing desc ---------- �----------- -- -------------_---- � {; ---•-•--------I__--------------------------------------------------------------------- ------=------ ------ ------------- •------ 11 ----- -------------------------••---------.------------------------•--- ------------------------------------------------ ------------------------------------------------------------ --..._------------------------- ---------------------------------------------- --------------------------------------------- •-------•-------------------••-------•-------------- ------------=------------,/------- -----=------------------------------------------------------------------ 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. , _ t --------------- _[Owner and/or Contractorl ! i C iBy:.--------- '��'`�` --------- �'` `=``n'----------------- •--------------=-------------=----------(Title)----- ------ ------ ----W------------------------------- (Plot plan, showing size of Vocation of system in relation to wells, buildings, etc., can be placed on reve•rse'fide). � FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----------------------- ------- ----- ------------------------------------------------- DATE ------•--------------- ----- 1 REVIEWED BY----------- ------------------- -------------- -- -- - - -------- ------- ------------------- DATE --1 ... BUILDINGPERMIT ISSUED-------------------------- ----- .---- ----------------------- --------------------------- DATE -- ----------------------------• ----- Alterations --- ._.... Alterationsand/or recommendations-------=-= -----------'-------------------•'----------------------------------------------------------------------------•----------•-------------------------- .�"" __ F, -- = ---- -_--- ------- V --- -- -- ------_ �__ ===-c*,-_ ° - _ --------------- -- - ------------ --------------------- i ------------ t;-n - ' o-, . " 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 3.57 F.P.CO.