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N /PLICATION FOR SANITATION PEf�! Permit No.-------- (Complete in Duplicate) ---- -- ..... -- ---- This Permit Exoires 1 Year From Date Issued Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to con;ttuct q�d;install the work herein descrbed. This application is made in compliance with u Ordinance No. 549. `"J06 ADDRESS AND LOCATION.......- d S Owner's Name..�-.1Y .._:.--�p - � ................ _... Ph ------ -------------------------- Address.......................... Contractor's -- -------- 0 -----....... Phone..........-......... -------- Installation will serve: Residence [Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ...J.- Number of bedrooms .1. Number of baths Lot size Water Supply: Public system ❑ Community system ❑ Private W-�Dapth to Water Table 6.f ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Q---Hardpan ❑ Previous Application Made: )If yes,date------- ..-,----. -) No 9/New Construction: Yes ❑ No ❑/FHA/VA: Yes [4---No' ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) //rd r Septic T Distance from nearest wek_.---'__-.Distance from foundation_.,/A../.......Mat vial.._- No. of compartments.....----.--_Size._-: s.,J.'� ....-Liquid de th._..-fir Capacity..... --_:--- Disposal 'eld: Distance from nearest well-:/ .!t.Distence from foundation. l ....-.Distance to nearest lot line_.4�---._.. Number of lines----------- -� g S '1.--Width of trench,_ -__�/..._----.-.._.---__ � a-. _.-,._3.�-_�.- l/_L�en Length of eachaine.....- _..._- - Type of filter material_.._ 164 WAG-i'Depth of filter material-_-.Y_ ----Total length...--,�-I.��______________�---------- Type (J Seepag tt: Distance to nearest well__/.0C2 ----..Distance fj.S� �o undation.....�.Q.-...Distance to nearest lot li;Ie tp Number of pits-.. ._.-.__--Lining materiaL...1,-QrEsY-._-..Size: Diameter-3.. .Y........Depth=-:" .--.. ._ .. ......Cesspool: Distance from nearest well---._-----------Distance from foundation--------------------Lining material-----------_--------._.._---------- ❑ . Size: Diameter---------------------------------,Depth-------------------- --------------------_...Liquid Capacity .................__..gals. S nvy: Distance from nearest well.........................:.......................Distance from nearest building - ❑ ---- - -- - - ...... Distance to nearest lot line------._"...-------'-._.----".-_"""'-.;>..._"_............-- - - _._ R Remodeling and/or, repairing (describe):.-----._------__ -_. ._ .G3� ----- -- ---,-----_ --- ..____- fl .� -{_. � e-5�-' ------------- . ............--------------------------------------------------------------- — ----------------------------------------- ---------------------------------............... I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State 1 sgnd rules regulations of the San Joaquin Local Health District, (Signed).----------- ------ - 't�- �'------- - -- ----------------------------------------------------- ..._---(Owner and/or Contractor) rtle_.-- (Plot plan, showing size of lot, .tion of system in relation to wells;buildings, eta, can be placed on reverse side). // FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-.-.--_--l�. - .......... . . " _ - -�-- -�•------------ ... - --- DATE..... -- REVIEWED BY---------------------------- -------------- - - ...-- - DATE ------------ - - - ---------------------- BUILDING PERMIT ISSUED............................... ---------------------- -------------------------------------- - Alterations and/or recommendations:...... --_._ _ ._C.. — - s� Yom'2 " � ..._ ............- - - _ -------............. ---------------- . . ..-------------------- . . ... . .------- ........------- --------------------------- ..... ---' -- - - FINAL INSPECTION BY:. �'� / -_. .. .. '. Dater/ fs SA JOAQUIN LOCAL HEALTH DISTRICT 1601 E. Hazelton Ave. 300 art Oak street 124 Sycamore Street 205 Wast 9th Street stockton, California Lodi,California Monte,.,California Tracy, Cvliforniw r.P.cv.