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ll ' APPLICATION FOR SANITATION�2 LAPERMIT Permit Noa__ __7__._ a6 (Complete in Duplicate) Date Issued .�__�_.�_=✓ Application 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 N 9. �d JOB ADDRESS AN OCATI ___4_-0- j--------------- ---- ------------------ --------- --------- Owner's Name-------- 1X.r� r + - ------- - - ---- - ----- - -- -_------------ Phone - ---- --------- - i - ----------5�--------------------------------------------- Contractor's I. Address_ / Name.------ Installation will serve: Residence .x Apartment House ❑ Commercial ❑. Trailer Court ❑ Motel ❑ Other ❑ I Number of living units: I------ Number of bedrooms ___/ Number of baths L_____ Lot size X_"d_X-----f.2%5" ------------------------- i Water Supply: Public system ❑ Community system ❑ .Private M Depth to Water Table.S,6_ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑ NoNew Construction: Yes ❑-,No TYPE OF INSTALLATION AND SPECIFICATIONS: 1 (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well________________Distance from foundation-------------------_Material---------__-______.____--__________-_-._________- ❑ No. of compartments--------------------------Size------••------------------------Liquid depth--------------------------Capacity----------------------- Disp I Field: Distance from nearest well_ ,____.Distance from foundation__ If_____Distance to nearest�l°t line_+�.�____-_ Number of lines___ � !---Length of each line----,Z'Ar!_ _a.-Width of trench____/-`'*�_�----------- Type of filter material_l-r�,__-_ ---- Depth of filter material______-_/___ _..__Total length___-.-__f Seepage Pit: Distance to nearest well___-------------------Distance from foundation----.---------------Distance to nearest lot line-___.____._______ ❑ Number of pits----------------------Lining material----------------- -----Size: Diameter-----------------------Depth---_------------•--- ------ Cesspool: Distance from nearest well-----------------Distance from foundation------------------..Lining material--------------------------------------- ► ❑ Size: Diameter-------------------------- ----------Depth----------------------•----------- --------------------L iquid Capacity----------------------------gals, Privy: Distance from nearest well--------------------------------------------------Distance from nearest building------------------------------- ________ I ❑ Distance to'nearest lot line_------------------------ I I R Remodeling and/or repairing (describe):----------------- ---------------- -------------------------------------------------------------------••-----------•- V ' ------------•------------•-----------------•-------- -----------------------------------------------------•-------------------------------------------------------------•------------------------------------------------------------- I hereby certify ve prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State 1 ws, d les and regulations of the San Joaquin Local Health District. {Signed) 4sysfem r ---f-- - ----------- -- -Owner Ind r Co tracforl .R By:-------------------------- ---- -- ----------�a (Title) - ----------- (Plot plan, showing size of of, location in relation to wells uildings, etc., can be placed on reverse side). FOR DE A TMENT USE ONLY APPLICATION ACCEPTED BY. W- _ ----------- - DATE-- ,--- � " R1VIEWED BY ------- ----------------------------------------------------------------- ---- -- DATE - - -- -- ------------------------------------- BUILDING PERMIT ISSUED e --------- DATE----- -- ------------------- Alterations and/or recommendations: - ------------------------------- ----___________________-______--.-_._____._____-_._...____-_---___-_______---___..____-__--____________--._.-_.._-____-_-._________________________.-________._--___-__-____--_________--__-Y-___ ------------------------------------------------------- _ ------------------------------------------------------ ------- FINAL INSPECTION BY:----------- = - = Date - /v, SAN JOAQUIN LOCAL HEALTH DISTRICT / / � xj/ 130 Soath American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California 1=S-9-2M 8-51 Revised W-2100 r= J