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/ ALICATION F017 SANITATION PER, J Permit No. _______________________ (Complete in Duplicate) P te) Date Issued ____ �!S-Z__.. I Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the+ r�herein described. This application is made in compliance with County Ordinance .N o. 549. JOB ADDRESS AND LO ------- ---------------- ........------------ Owners Name-----------=V -64 ------ ------------------ Phone__ ." c ` Address---------------- --- p -- ------------------ ----••---------------------•----- = Contractor's Name-------------•- --------------- Phone__. Installation will serve: IrResideence,�--Apartment House ❑ Commercial ❑ Trailer Court ❑ M tel ❑ Other Number of living units: A-_-_ .Number of bedrooms _Z___ Number of baths _ Lot size ._-_ -_- - - - --------------•-- ------•----------- Water Supply: Public system ❑ Community system ❑ ' Priva fe ❑ `Depth to Water Table:,N_-d.•ft. Character of soil to a depth of 3 feet: Sand'❑ Gravel -Sand E_oaA y []` Clay Laam El Clay ❑ Adobe Hardpan El Previous Application Made: Yes ❑ No.❑ ,. New Construction: Yes [] No ❑ TYPE IOF INSTALLATION RAND -SPECIFICATIONS: (No septic tank or cessppermitted if public sewer is ayeilable within 200 feet.) a ool.. Septic, Ta IJ+s+ante from nearest well -P_".:-____Distance f �ndation 1.Q_r__-__-Ma erial '� -i�`c,I '-,No: of compartments.- 9611- v 9 -----�� Si - �-�-"-----�'Liquid depth��p--------------Capacity---lam�� p al .laid: Distance-from nearest well, t -----a' a ce from found ,-._•.Distance to nearest lot line... . Number_ of lines__.s fr-. ------Length of each line .D._-.-_ Vii_,--._-Width of Type.of filter material_l�._?!--------- -----Depth of Ater material___-/ Total length__.. ? Seepa�° Dist ...... f /� -------------- Pifi: ance to;nea st well- --__:-_Distant ro _fo. ,dation___- 1JJ�/_ Distance_to-'nearest lot line--__- _D � .-� _ !�!u�mber of pits, --------Lining-aterial_ .Size: Diameter�!"'k- Ste tn- Cesspool: Distance from'.nearest well____-----_-_--__Distance from foundation---------------------Lining material------------------------------ ❑- : Size: Diameter--- •-------- - --- ------ Depth------------------------- ----------------------------Li uid Capacity q -------------------••-------gals. Priv r est well-------- _----._Distance from nearest buildin - g -... - ❑. Distance toonearesfiE;lot line------•------•--------=---------------------• - - _ f Re��elrnd/o �ir g !be � '+ _�- - t� _ c� - r r :rt descr. t G�a� _ Aw. n. f 'hereby •the+ I have -- ' -- ------- I prepared thi application and that the work will be done -n accordance with San Joaquin County ` ordinances, 5+ a is s,•and rulesjd regular' ns of the San Joaquin Local Health Disfricf. r .,�s _ (Signed} �- -------------------- ---------------------- Contractor) -- (plot P By , n rat o - [Title} iv ,£/_. 1 Plot Ian, showing size.of lot; location of.,system' .relation to wells, uildmgs, etc., can be p aced on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ------ --- •-----------------• --------- DATE.: REVIEWED BY ---------=---•----------------•----•------------------=---------•------------..._ DATE -oma BUILDING PERMIT ISSUED---------------- •--•------------------------•------------- ---------------•-•-------------••----=--------_.-..----------=----------------------- DATE------ Alterations and/or recommendations:- = -----------•----------------------•---------------•---------------•-------•--•-- -•----_.---•-----...----.-•------ I ----•--------------------------•-------------•- --- •----------------------•---••-------------- ------ --------------------------------- ------ - ------------- ----------------•••--•---•-----=••--•----••-- 1 FINAL INSPECTION BY:----•--- I - 5 _ ..... . Date -_-------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1 130 South American Street 300 West Oak Street 132 Sycarnore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California E$-4-2M : Revised W-2100 '