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V APPLICATIONMR SANITATION PERMIT Permit No. ...... �..9.0_ {Complete in Duplicate} Date Issued .._.. ... .�� Applical-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. 549. JOB ADDRESS AND LOCATION--- ,. --- f -'---- -- --------------• --------------------------.---------------- Owner s Name-------. � '-... Phone. Address -------- - -- ; -� ^------------------- -- - --- - ----------.------------.--•-------------------------------- - - --------- Contractor's Name---------------- �- -� -"� Phone Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ If Number of living units: _/_.- Number of bedrooms -.--_ Number of baths __L Lot size -_-_---5_,O `!?-r. ---------------- Water Supply: Public system M-1—ommunity system ❑ Private ❑ Depth to Water Tableft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe [ Hardpan ❑ Previous Application Made: Yes ❑ No ❑ New Construction: Yes ❑ No ❑ TYPE OF INSTALLATION .AND SPECIFICATIONS: • (No septic tank or cesspool permitted if public sewer.is available within 200 feet.) Septic Tank: tf }Distance from nearest well) -.f-Distance from foundation----14P--------- Mate�ral- -;No, of compartments .............. - _,��_�Q--___Liquid depth_-.- {- Capacity..-- -Size -J-10-:1 - Disposal Field: Distance.from nearest well---/Fn4fftDistance-from foundation--------------------Distance to nearest lot line----------------- Numbei o'f lines-------------------- ------------ -Lenth of each line-,-_ '' --� Width of trench----�-�-------------------- 9 ,. ' of Type of filter material../�X Depth of filter material---. -_ -.Total length------ --------------------------- Seepage Pit.: Distanceto nearest well---' Distance from foundation-_-; 'r p-_--....D' tante,to nearest lot line----------------- G Number of pits--------f.-----------Lining mate ria'l_C&-Alf'is iie: Diameter_'�-`-------Depth------0?1::7 ---------- 1 Cesspool: Distance'.from nearest well----------------- fouriclation---------------..--.Lining material------------------------------------- ❑ Size: Diameter--------------------------------------Depth---------------------------------------------------Liquid Capacity---------------------------- gals. Privy: Distance from nearest well------------- ------------------------------ .--Distance from nearest building----.-..-_-__-----_-----. ❑ Distance to nearest lot line----------------------------------------------- _--••---------------- ------------------------------------------------------_----------- Remodeling and/or repairing (describe):--------- -------------- '----- ...... _ - C�-- - •----- € --------- -----------------------------•---------------------------....------- --•------------ ---- ---•--------- ----------------------------------------------------------------------------------------- ---------- --------------------•---------------------------------------•-------:-----------------------------------------`-------------------------------------- ------------------------------------------------------------ I Hereby certify that I have prepared this application-and that the work will be done in'accordance with San Joaquin County i ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. i 4 _ .. -" __ _. ._. - ------------------------Owner and/or Contractor [Signed}.-------•---------- ��- ---•----=---- --- '- -- -- -�✓�"�'c- [ / ) By: - ------ '------------------------------------{Title) - Ef' .-------- (Plot plan, showing size of lot, lac Ion of system in relation to wells, buildings, etc., can be placed on reverse s''e). FOR DEPARTMENT USE ONLY APPL ---------- ----- --------------------- ---------•-------------------.--. DATE.-__-`------•--------- ------------------------------- REV�IWEDI BY--ON ACCEPTED BY DATE -- ---•-••----- -••--------•------------------ 1 BUILDING PERMIT ISSUED - = DATE. - �' Alterations and/or recommendations----------------------' e - " v_______-•.--•--------------___-.. !' ------------------------------------------ I ------- --------------------------------------------..-------------------------- - - -- -------------------------- -------------- -------------- -----------.- •- -- - --------------------- FINAL INSPECTION BY: ------------------------------------------ _.. Date -117. ---- --------"'------- -- T . i -SAN JOAQUIN LOCAL HEALTH DISTRICT l 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 145446 A7wuuP