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q 'PLICATION F,. 3 �� OR .SANITATION P. ,AIT Permit No. .13----------------•- 1 / f (Complete in Duplicate) l .I Date Issued I i Application is hereby made to the San Joaquin Local Health District for a permit to construct and installff This application is made in''`compliance with C n O dinance o: 549. JOBADDRESS L AT N .. ---- ---- - ----- ....... - ---------------------•----------------------•-----`J Owner's Name..-- ........ iE ------- ---- � _ . .____--- - -----------•----------------------- Phone Address ,i - `- -------------•--•-•---------------------•---------------------•---••---•-•---- ---..-----------------------------------------.....-••-•- --------------- Contractor's Name.. -------------------------------------------------- ----------------------------•---- ------ Phone-------_-_------------------- I lnstalla+ion will serve: Residence Aartment House 1 Commercial E] Trailer Court L] Mot I [IOther ❑ �. Number of living -_ _.-. Number m -- --------------- ber of bedrooms _- -_._'Number of baths _ Lot size ___ .- .-_-._-__'_-- Water Stipply: Public system 6v�CoTI munity system ❑ Private [!f-'Depth to Water Table -------- ft. �I Character of soil to a depth of 3 feet: ! Sand Gravel ❑ Sandy Loam Clay Loam E] Clay E] Adobe Hardpan Eli Previous Application Made Yes ❑ I10 Q PNew Construction: Yes [ No ❑ TYPE OF INSTALLATION!NAND SPECIFICATIONS: (No septic tank or cesspool permitted if publi sewer is available within 200 feet) j r — Septic ank: Distance froo m near st well-- -Q---1�'`_tDistange fr f dation. __---------Mat �ial-----------------GU -----. -__.- �-= ,' -- ze x Liquic#rgeP.tharfrne --- - ---------CapautY Q._ r------ . J Dispos�3 Field: Dis#ancie from nearest II _--.- istanee from foundation- � ' istance to nearest lot li � .✓• ,❑' Type ofi of lines___.__.__ Length of each line______________ Width of trench-.- .- �1 Number -- -------- filter mater r - -r ---- epth of filter material----_J--- --------Total length-----... -----------•-••-•--------- Seepage Pit: Distance to nearest well -----------------Distance from foundation--------------------Distance to nearest lot line----.------------ ❑ Numberr of pits---------------I----..Lining"material-----------------------Size: Diarne#er-----------------------Depth-----------------•--------------- a } Cesspool: Distance from negrest -----------------Distance from foundation.....------------__Lining material_---.-------.----.--..-.-_-----.-.-- f ❑ Size: Diameter----------------- -------------------Depth..--------------•----------•-- ---------------------Liquid Capacity----------------------------gals. pn Privy: Dista a from nearest well-__.--.----____--------------------------------Distance from nearest V r9 ---------------•---------- . ❑ Dis nce to nearest lot l e----•---------••--...---•••------------------- -••------------------------------ a � Remods ifsg and/or re 'airing (describe:----.-__}_----••-------------------------------------------------------------- .. /J`r/ r ' Sl.u ..-------------•'•-----•--------•---••--•---•-'`-....-------------------------------------------------•--------•--------------------------------------------------------••----------••--•------- II •-------•-• ------•---••------- ----- --------- = ------------......-- iI } ordinances, State law , and ...------••--••--••--•------------------------•-•----------•••----------•--•-------------------------------...--.-----------.-...----------------------------------••--••---- hereby y have prepared this application and that the work will be done in accordance with San Joaquin County rules and regulafions of the San Joaquin Local Health District. (Signed).... �� •-•---• ----------- -------------------------------•--------------------------------------(Owner and/or Contractor) (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 EWEBY TI ACCEPTE6r B - ------- --------- '--- --------- ---------------:------------------------------•---- DATE.. ----•- It---------------- -----------------•------------------------------ - DATE = - j BUILDING PERMIT ISSUED------------ ----••-•--------•---------------------------...----------------------- ---••--------- DATE.-----•-1 Alterations and/or recommendations---------------------- ----------_----------- ---------••-•-------•-----------------•--•-------- •----- -2---------------------__-----••------- / - -- -------- ------ ! ...G--------------------------•------------------------------------------------ --- r..._-.-.---------- - ------- ------- FINAL INSPECTION BY:;----.-r �` -•-•--• Date - ------------------------ 'I SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street l 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California -1" Lodi, California Manteca, California Tracy, California .ES-9-2M 10.52 Revised W-2100 it ----