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_ � r APPLICA 71ON t=OR SANITATION PEftk"`,A. " Permit Not -�—�r. (Complete in Duplicate) Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the worgierein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCA I W 1y0vd�� J Owner's Name-�--------------- l_�. !��-�7Q-J,, � ��-]-�- / i " ! ! ?_vl_C 7f------ ----------- Phone----------•------------------------ ------------ --------------------------- -------------------------------------------------•------------------------ p r� d3 �r?h Contractors Name --------- ------------------------------------------------------------ Phone----- '? -'•. Installation will serve: Residence ❑ Apartment House II ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other , 8oas�c.t Number of living units: -------- Number of bedrooms -------- Number of baths -------- Lot size -------------- Water _________Water Supply: Public system ❑ Community system ❑ Private ❑ Depth to Water Table _______ ft. *0r ...,,`� Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam,N Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑i Previous Application Made: Yes ❑ No New Construction: Yes ] No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (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----•-------- isposa Field: Distance from nearest well_________________Distance from foundation--------------------Distance to nearest lot line----.-_________-_ ❑ Number of lines-----------------------------------Length of each line------------------------------ of trench----r____________-______,_--____- Type of flier material-------------------------Depth of filter material-----------------------Total length-----------------------------,------. Seepage Pit: Distance to nearest well__ -------------------Distance from foundation--------------------Distance to nearest lot line-_________-_.--- ---------- __ F ❑ Number of pits Lining material ---------.Size: Diameter-----------------------Depth-------------------- - esspool: Distance from nearest well---------_-------Distance from foundation--------------------Lining material_____-_____-_-______ ------------------------------------- El Size: Diameter---------- ---------------------------Depth--------------------------------------- -----------Liquid Capacity----- gals. Privy: Distance from nearest,well------------ - --------------------Distance from nearest building $7 -! Distance to nearest lot line_______-_,_�-Q---------- ---------------------------------------------- r Remodeling and/or repairing (describe):-----•----------•--------------A-'------------------------ 1 -------------------- -------------------------•--- 11 1 :1 -r. ---------•----------------.-..---------•--------------------- --------------------- ------------------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)• r� "�'" -� -- z_ • - - ' _ (Owner and or Confracfor) BY: -�- ------ -- �� :� � - -----•--------------•----------------(Title)__ 1 t ,� (Plot plan, 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 ---------------- --------------- f - DATE------------ ---- - ---- ------- c.. REVIEWED 8Y_------•------- -- ------------- ------------- ------- ,�,,-�---�----------- -- ---- ------------------------------ DATE /, --------------- BUILDING PERMIT ISSUED----------------------------------------------------------------------------------------------------------------------------------- ---------------------------- DATE---- --------------- ---------------------------------------- A aerations and/or recommendations:_______._._______-___.____________________ ._ --------------------------- ------------------------------------------------ L; --- --------- ------------------------ --------------- ;?e7 FINAL INSPECTION BY:_- Date SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West 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