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APPLICATION FOR SANITATl01 PERM Permit No ----------- ___ PT�p (Complete in Duplicate) �� date issued - --------•--- lica+ion is hereby made to the San °Joaquin Local Health District for.a permit to construct and install the work herein described. s application is made in compliance with County Ordinance No 549. } JOBADDRESS AND LOCATION__�.'_---------- —---------------------------------------------------------------------------------------------------- .:- rr I , Owners Name------ • -->S-f------d+r / 1"d------------- --'---------------------- Phone----"---------------•------.._...--- Address---------------- Contractor's Name 0--��- ----- l".... Q -ter' ... .....�----- -----�^^ a- -------------------- Phone----•"-------------- ---------- -- installation will serve: Residence ❑ Apartment House Commercial ❑ Trailer Court ❑ Motel ❑ Other [) Number of living units:__ Number of bedrooms Number of baths y--__ Lot size Water Supply: Public system 1< Community system ❑--Private [I Depth to Water Table---------- ft. 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 14.No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS:* r (No septic tank or cesspool permitted if public sewer is availa6le-within7200 feet.) t Septic Tank: Distance from nearest well_)WjDiV2t.-Distance`from-foundation---- _-_______.Material P �------------ Size ._2�,�y s Liquid depth.__--- =----- No, of com artments_:_---- -.-- � --------_--Capacity.__��_�_--_-- ` Disposal .Field: -Distance from nearest well_1/6ffity/tDistance from foundation--!___.)-------Distance to nearest lot line----1._�__:_ Number of lines__' ----------- Length-^ o _f each line11___�__eY'_'7OWidth of trench_ y Type of filter materiakST !_C___- 4�e 6 of`filter material_19-------------Total length______ _ U _______________-___- r t z .. I f Seepage Pit: Distance to nearest well,_-0-�t_R,iDi0ance from undation_1_Q_=_:_�_-.__.Distance to nearest lot line__._-�_______ Number of pits.-..------- ------Lining materialC__�--- ----�'�-�i��.Diameter---- -3~..__.._f-Depth....__y_ _�----------_""--- p�1 Ces pool: Distance.from nearest welt----------------F Distance from'foundation__---- "___:___.Lining material___----------------------------------- T ---- D r --- - ----- - - -�------- apace y--- ---- ...°s' Privy: Distance from nearest well_____________________________________________.,__Distance from nearest building-------------------------------------------- ❑ Distance to nearest-lot-line--------------------------------- Remodeling ____________________________ __Remodelin and/or repairing descr:b �!h1 = 4/ ._ Q 1, 1 N p --------------------------------- ----------------------------------------- ----•---------------------------------------------------------------------------------------------------------------------------•----------------------------------------------- ; P-..� ------------------------------------------------------------------------------------------------------------------------•----------------------------------------•------------------•----------------------------------------- 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'0oaquin Local Health District. � tt � iC✓ (Signed) -�� --------------------------------------------(Owner and/or Contractor)4 By:-----------•----------•-•--------------------------------------------- , _ - ---------(Title)----- ^ =' - (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). tiS Y r p4 FOR DEPARTMENT USE ONLY APPLIREVIEWED BY----------------------- ------------ -- ---------- " DATE -- CATION ACCEPTED BY-------------------------- ------- DATE--- -_ - ------------------------------------ ---------------- BUILDING PERMIT ISSUED-------------------------------- --- ---- ------------------------------------------- -_- -- DATE-------------------- Alterations and/or, recommendations:_- _ C -1 ------------------ r ; _ _ -------- ------ ' ' :: ----------------------- r /_!-------------- ----- ---- FINAL INSPECTION BY------------ = * " Date------------- 1� t ° -------•----------- c� "ate OC DIS RICT '114� � 130 SouA Ameri S+ 300 We} Oak $treat - 132 Sycamor Strea+j /] 814 North "C" S+re t Stock+ort, C.1/6"' .-� L Calf - ante , . i ornj�;, / Tracy, Califo ES--9--2M - Revised W-2100