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r ' 1 APPLICATION .AOR SANITATION �, 3 •,,� N PERMIT Permit No. .. .-7---__�____,- (Complete in Duplicate) A � .�. Date Issued-, I Application is eraby 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----------------YOLl3-- F S1X1�i ---------------------- --- [[I --------------------------------- ----------------------------------"---------- Owner's Name------- ----------------TQ � T•-------- - P-Jl Phone Address------------------ S fY1/fii/ ------•-•--- C'ontractor's Name------------".------------------ _ - -- - --------------------------------------- Phone ---------------------------- Installation will serve: ,Residence* Apartment House ❑ Commercial E] Trailer Court ❑ Motel ❑ Other-E]Number`of living units: -------- Number of bedrooms Ar--- __ - Number of baths --_- Lot size --------- _ Water Supply: Public system ❑ Community system ❑ Private X Depth to Water Table -------- ft: '? Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe)`J Hardpan ❑ Previous Application Made: Yes ❑ No New Construction: Yes I� No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: �` I � r (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank} Distance from nearest well----------------- from foundation-------------------- Material ---- ,, ❑ it) Na. of compartments------------ --------------Size--------------------------------Liquid depth------------------- -----Capacity----- 1 Disposal ield: Distance from nearest weH__ 70-_._Distance from foundation------,�a_-------Distance to nearest lot line____--�_-___ Number of lines_________________ _�_ _- Length of each line------ X �x_3DWidth of trench- _---_ ,� # Type of filter materrai__.__K,� Depth of filter material--____ rT -q------------------- - -�----- ��--------- Total length--------1�11--6 Pit: Distance to nearest well_-"_"----_--__ ___Distance from foundation-------------------.Distance to nearest lot line_---- w ❑ Number of pits---;------------------Lining material-----------------------Sizer Diameter----------------------Depth-------------------------------- Cesspool: Distance from nearest well-----------------Distance from foundation__---- -_----.Lining material Size: Diameter------------------------ ---------Depth-----�-------------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well-------------------------- Distance from nearest building [']. distance to nearest lot lineb, - - -- -- - - - -------- �l✓J_ _l��j-------- (gyp--- -----------;------ ---------- --------- - --------- ----------- ----- Remodeling 'and/or repairing (describe):______ _ _ / �/ ----- ---------------- ----------------- - --------------------------------------------------------------------•----------------------------------------------------------------•----------------------------------------- I hereby certify that I have prepared this application and that +he wore��wwill be done in accordance with San Joaquin County ordinances, Sta la , and rut and regulations f he San Joaquin Local-lealth District. 9 " (Signed,)---------- - -•--- ------ ---------------------------------------{Owner and/or Contractor) By:------------------------------- Title (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). ## -------------------- i FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED_BY----------------------------------- -------- ----- W = DATE 15 ' REVIEWED BY--------------- E f DATE - BUILDING PERMIT ISSUED--------------------- - " ------- ------------------- -------------•-------------------- ------------ DATE----------------------------- -------------------------- A ------------------- Alterations and/or recommendations:_:_� :�_,____- -- ----- ------------------- ----------------- i --------------------- ------------- _------ :------------------------------------•-----------------------------•---- ---------------------------------------------------------------------------- ------------------------------------------- FINAL INSPECTION BY _____" ~` ----- Date------- SAN JOAQUIN LOCAL HEALTH DISTRICT r 130 South American Street 300 West Oak Street 132 Sycarnote Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M 8-51 Revised W-2100