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f N PERM APPLICATION FOR SANITATIO -- ----- (Complete in Duplicate) .�_.� ate I ed Via, s_. �sK�v�ay_ 451 _ r�� OZo- n Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the worktrein described. This application is made in compliance with County Ordinance No. 549. x _ JOB ADDRESS AND LO TION 1' a? ro � �� _ _...> q ` ' ��--el-----F.••`,P Gfi-r-----=---- ...... Owner's Name--------- aPf!�9�c ------- Address -----�`./L%.....1 .-�•--....._.... Phone............. Address.....-•............. ------------ = --- - - •-------....__ ...........---------......--•---.......---....---- Confiractor's Name. , l.- ? �r ..... 1'> 1 :o.�.t... Phone................................... f Installation will serve: Residence ❑ Apartment�e ❑ Commercial X Trailer Court ❑ Motel ❑ Other ❑ I Number of living units: _ _ _._ Number of bedrooms ........ Number of baths ........ Lot size -_........ ................................ 1 P Water Supply: Public system ❑ Community system ❑ Private JK Depth to Water TableGrR-1;' ft. i { Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam W Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: Yes ❑ No K New Construction: Yes [N No ❑ FHA/VA: Yes E] No ❑ { TYPE OF INSTALLATION AND SPECIFICATIONS: rr� (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) I. or Septic Tank: Distance from nearest well_-50_ Distance from founc�jion..lp.___.__._..Materia!.........__. ........ (f --------- -. ® No. of compartments........ ...... _ -- p. --- P Y b __.____-.Size.-._... _ ,__Liquid de th.....` ._. ___.Ca acit D.-.D.-....._.. Disposal Field: Distance from nearesr�t well. -'- . ._. -- .. Distance from foundation. Distance to nearest lot Number of lines------Lrr.-___--._ Length of each line.... ! _.._ _ r Width of trench...rZ_�,c.... ................ . r &... Type of filter material..5e - Depth of filter material.._..[. -__ .---..Total leng+h..._..� ��...........:.....__.... s Seepage Pit: Distance to nearest well..................._---Distance from foundation-----------------...Distance to nearest lot line................. ❑ Number of pits_... -------------..Lining material---------.`............-.Size: Diameter..... -.—�........_Depth......_.......................... (� Cesspool: Distance from nearest well.................Distance from foundation___._.__._-._-_-...Lining material..................................... ❑ Size: Diameter.........................••-----------.Death.---------------------------------------------------Liquid Capacity----------------------------gals. C Privy: Distance from nearest well....:...........................................Distance from nearest building.......................................... ❑ Distance to nearest lot line----------•-----------•------ •---------------------------------------------------------•--•--------------•----------- - -------- = -ram- ..../.4- ' �- 1/ ----- ----- --•-----------Y, . f .............................................------------------•----....................................... t - ----------------------------------------------.------------------------------------------..................... I hereby certify that I'have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Stat Iaws,,arfd7u1e1a�nd regulations of the San Joaquin Local Health District. \^ f�•(Signed) -.- .,+.rt te,ryte � g�'eel Contractor ----------------- ------ - -- ) �) (Plot plan, showing size of lot, location of sys}em in relation to wells, buildings, etc., can be placed on reverse side). `� OR DE R ENT SE ONL APPLICATION ACCEPTED 8Y.- ....t... --•-- --- - "`,ri(`t> DATE.... ? REVIEWEDBY----- --------------------------------------------------•-------- -------._...------- ------------------------------------ DATE............................................................ BUILDINGPERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE-----........------•----••-•----•--•---•----•----------_.... Alterationsand/or recommendations:.. . .:...............•--•-------............................................. . ..-------------•-------._........-•------------------------------...... : , ... •-----•---•-------------- -------------------•-------- ...._............-•----•--•-•-----............------•.................................... ----------------------------------------------------------------- ..........................................................-------•-..........._............................................................................................................................................ -••------•---•...........................................................................•---......--------•............---••------......_...........-----•--.......-•-------••-----------.......................... ........................................---------------- --.......-•-------............................-•--._..........................._1K............................................ FINAL INSPECTION BY:. = -' ._.. Date-----.�1;/ X�.../ ,� 3------ --------••--• ._............._. I" � 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 . Revised 1.57 F.P.CO.