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A PLICATJON 1,OR SANITATION PERMIT Permit No. _____Ftl_ _- '—(complete -in Duplicate) - Date Issued ---V 7 Applica-•ion isereby 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 Coun Or inanco No 549. JOB ADDRESS AN LO ATION-�---- •------------------------ -- -- -------- - ------------------ ---- - /� (� ---------••-------------------•--------------------------------------------- -----•--- Owner's Name - -�r--l • ---- .�___� � ------------- --------------------- ------ Phone------------ f Address_-.------- - 1 -CI a/✓ --•------------------•---------------•-••---------- •--------------------------------------- Contractor's Name---------------------- -------------- --------------- Phone Installation will serve: Residence Apartment House 0 Commercial E] Trailer Court ❑ M tel ED Other E]Number of living units: j---- Number of bedrooms ._ --- Number of baths . -- Lot size ___�__ : Water Supply: Public system ❑ Community system ❑" Private p Depth to Water Table -------- ft. r Character of soil to a`depth of 3 feet: Sand ❑ Gravel,E] Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Er—TI'ardpan ❑ Previous Application Made: Yes ❑ No New Construction: YesMo ❑ F TYPE OF INSTALLATION AND SPECIFICATIONS: 1 (No septic tank or cesspool permitted if public sewer is available within 200 feef - Septic Tapk: Distance from nearest well ____._ _ _DistanSe from foundtio _____.__._._M�fi _ Z. ____ _________ _No. of compartments______ � t!Q �____Liquid,depth_ - _ lJ C1U� ---------Size_ _ � _ --- CapautY--�--------------- Disposal •eld: Distance from nearest yrell...._____.._-_._Distance from foundation_.__ .`` �/ ' / 1�___..._.Distance to nearest lot line__/0__ ____ { 190 Number of lines__..-------•,------- Length of each line-------647 ---.---.Width of trench___ _y_--_-_--.__---__-•--_ Type of filter materialC•�_ -Depth of filter mafierial --��-- Total lengthD -------- Seepage Pit: Distance to nearest waft_._ ---__--------Distance from fo dation___ _____.___.Distance to nearest lot 'ne______..___._____ I p __--- ----Lining material___ .__.Size: Diameter___ '-- Depth..._.._- , [� - _ Number of its.r-.-l. -- � - -------- - --- Cesspool: Distance from nearest well-----------------Distance from foundation------------------- Lining material___________________________________ ❑ Size: Diameter--- ---------------------- -----------Depth-- Liquid Capacity 1� ------------gals. Privy: Distance from nearest well___________________._ .___. --- from nearest building ❑ Distance to nearest lot line-------------- Remodeling and/or repairing (clescriEe) -----------------------_-----_-------- -----•----------------•-------•-------------•------------------------------------------- ---------------- -----------------------------------------••-•--------------------------------------------------------------------- ------------------- -------------•----------------------------------- hereby certify that I have prepared this application and'tha+the wo�&will be done in accordance with San Joaquin County ordinances, State laws, and rulesand regulations of the San Joaquin Local Health District. --------------- ---- ---Y-------------------------------- -- - --{Owner and/or Contractor By—_------------------=------------------------ - ------------------------------------ - -----------------(Title) _ (Plof plan, showing size of lot, location of'system in relation to wells, buildings, etc., can be placed on reverse side]. FOR DEPARTMENT USE ONLY APPLIC TIONACCEPTED BY------ ---------------------- - --- ------- ------ ----- ---------------------------------- DATE----- }� REVIEED BY-------------------------------------- ---------- -------------- --- -- -- DATE---------- - ?Y BUILD�4G PERMIT ISSUED-------------------- DATE -------------------------------------------- -- Alterations and/or recommendations:__..__..._- --------------------------------------------------------------- -------- ---0 L --------------------------------------------- ---------------------------------------------------------- ---------- --------------•--- - - == _lJ---- - d--------------------------------------- -- ---- ---- .� `v`` ------------- FINAL INSPECTION BY: - -- __.- Date---62t7 SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 30D West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9 145446 ATWOOD