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APPI_ICAT O FOP, � N � • SANITATIO _ PERMIT Permit No. -el 1 (Complete in Duplicate) Date Issued A0_-"f-Q S� App kation is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application!is mad rn compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION_........ f ------ ---------------------------------------------- Owner's Name.--= --•---------- 1 '--- Phone__•.- Address__.`=-------------- _ --------------- --------------- ------------- --------------•---------------------- ------------ ----------------------------------------------------------------------------------------------------------------- ------------ E Contracfr' Name______________ Phone -------------------- Installation will serve: Residence partment House ❑ Commercial "•` ❑ Trailer Court ❑ Motel E❑ Other ❑ Number of living units: _1_-__ Number of bedrooms ---- Number of baths -"�__" Lot size .____-" Water Supply: Public system Communit system. � Y Y ❑ Private ❑ Depth to Water Table -------• ft.. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Gay ❑ Adobe ardpan 0 Previous Application Made: Yes ❑ NoNew Construction.- Yes TYPE OF INSTALLATION AND SPECIFICATIONS: (No sepVc tank or cesspool permitted if public sewer is available within 200 feet.) V Septic Tank: Distance from nearest well_ 44-Ir ePistanc from fou dation_-__�_._ MatQj ai___ -�, No. of com artnients___"__ _ _ � "" p ._--Size__---X--- - Liquid th""--- Ca acit Disposal Field: Distance from nearest II"-/� p y--""" � { __e..istance from foundation___-- Distance to nearest lot line___- Number of lines____________ _ ________ Len th of each line___ p� g — -dWidth of trench-------- z� Type of filter material ' Depth of filter material_---__ ". �� """ -""`" 1 Yp y- - f ----------Total length------------J.-I - --- I 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---------------- from foundation______,_____-___--_.Lining material____-_____-___"__"" ❑ Size: Diameter----- --------------------------------Depth---------------- s - I ----Liquid Capacity----------------------------gals. Privy: Distance from nearest well_______________""__" _________________________Distance from nearest building------------------------------------------ ❑ Distance to nearest lot line_____ ___" "-___""-"""- - ' -------------- --------- - Remodeling and/or repairing (describe)_________________ _ ---- ------------ --------- - ----- - ------ - '_' -------------------------------------------------------------------------------------------------------------------------------------------------------- ------- ------------•--------------------------- ------- 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. (Signed)-- - - -------- ----------------------------------------- =----------------- + caner and/or Contractor) -- --- --------------------------------------(Title)------------------- (Plot pian, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_____"""" "" --k-------------------------------------------------------- DATE------------ REVIEWED BY ------------------ ----------- Q- -��--��--- --------------- --------------------- ------------------------------ DATE------------------- . BUILDING PERMIT ISSUED-------- ------ -_--------- ------ ----- ------------------------------------ --------------------------------------------------- Alterations and•,�,or recommendationsrofes,------- _ _ � DATE----------------------------- - -- -•----------------------- µ/ms $ --------- -------------- ----,�*.,; ------------------------------ ----------•------------------------- ----------------------------------------------- �-- - ----------------------------------------------------- -------------------------------------------------------- FINAL INSPECTION BY-------------- " ----_------------- f ~ : ,. ----- e_ Dat - -------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 Wes} Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M 8-51 Revised W-2100 l