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r �ICATION FOR SANITATION PER, -- A Permit No. --------------------------- --- ------------------ (Complete in Duplicate) --- ------------------------------------------ - This Permit Expires 1 Year From Date Issued bate issued ----------------- I Aplication is herebygp made to the San Joaquin Local Health District fora er nstruct a d i I the w�,prk here: s i This application is made in compliance with County Ordinance No. 549. '�c ,t' lGc y,J [~� L JOB ADDRESS AN LOCAT N �7`.(c ± i LZ `--- `--`----------%------- -------------------------------- Owner's Name----- - � ��t----------------------------------------------------- Phone.-- --- -- ------ Address--------.--.s -;--- - ---- -------------------------------------------------------------------------------•-•---------------••--------- i Contractor's Names -- - 3,' 1�. ....�.--�� Phone.--� __ �]-7'� J Installation will serve: Residence ❑ Apartment House ❑ = Commercial �;�Court ❑ Motel ❑ Ot r Eli Number of living units: -- ------ Number of bedrooms --------- Number of aths -------- Lot size _ - -- --------------------------------- Water Supply: Public system ❑ Community system [IPrivate. Depth to Water Table ........ ft. Character of soil to a depth of I feet. Sand ❑ Gravel ❑ 'Sandy Loam'❑ Clay Loam [] Clay ❑ Adobe lardpan ❑ Previous Application Made: (If yes,date-----------.--------) No ❑ New Construction: Yes ❑ No �HA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewerjis available within 200 feet.) S •c Ta k Distance from nearest well-----------------Distance from foundation_____.-_--- .--_.Material_.___.-___----_-_----------------_--____.___. --_____.Capacity .0'�`� No. of compartments--------------------------Size--------------------------------Liquid dep`h------------------ --------------------f No Ad• Distance from nearest well_Z_k . Distance from foundat�,y� � ��-. Distance to nearest lot line-.--F � / Number of lines------Z-........ -_.--Length of each line / -...Width of trench_.,*f--------------_-.- F Type of filter materi l c� i._-Depth of filter material___._.__------Total length-.; W---_ i Se g Distance to nearest well----------------------Distance from foundation-------------------.Distance to nearest lot line----------------- FA C Number of pits------------------ ---Lining material------ ---.---------...Size: Diameter-----------------------Depth------------------------.-.-----. Q Cesspool: Distance from nearest wel€_---------------Distance from foundation--------------------Lining material-._..__--..-..-----.---------_------ ❑ Size: Diameter- ------- ----- --- ----- -----Depth------------------------------------- -------------Liquid Capacity-- --------- --------------gals, S F. Priv Distance from nearest well.---------_-------------- -___----..-Distance from nearest building ----------------------------- \ ❑ Distance to nearest lot line ------------- - -------------- - - ----- ---------------------------------------------- ---------------------- -------------- -- -------------------------- Remodeling and/or repairing (describeli:- --------------------- •--------------------------------------- --------- 3 ---------- -------- -------------------------------- - itip'. = '- ----- --------- --- -------------------------------------------------------------------------------- ------------------------ I hereby Certify that I have prepared this application and that the work will done in accordance with San Joaquin County ordinances, State laws, and rules and regulations he San Joaq ' Local He District. (Signed-Q 114�L t' - lrz-' `( et-Contracfor) (Plot plan, showing size of lot;location of system in relation wells, buildings, et ., can be placed on reverse side). �!} FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------------------ -------- ........-------- --------- DATE--------------- -7`1� _14'..-66------------ REVIEWED -------- - BUILDING PERMIT ISSUED-------- ...... - _ ------ DA•TE------------ REVIEWED BY--------------------------------------------- --- ---- ---- -------- -------- -------------------------------------- DATE.--------------- --•--- Alterations and/or recommend at�ons:-----Y �'� 1-------- o-----, cX .----- // rerr-- - `-_ roc ------------ --------------- --------------- ---------- ...................I------------------------------------------------ ----------- -- ----- ------------------------------------ ---- ---- - I------------------ 0 ---------------- ------- ----------- ------- ------------------------- ---- ------------- ---------------------------------------------------------------------------. -------------- --------------------------- FINAL INSPECTION BY.-.__.__ L/ -- Date_._.._--�� 1� , f F! SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hacelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F1, i