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`LICATION FOR SANITATION PEf 'T Permit No. ... .�Z-��_rt (Complete in Duplicate) orr/ I.9l Date Issued ..... ,Z7 ,.C" - Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. �- This application is made in compliance Jwiitthh County Ordinance No. 549. JOB ADDRESS AND LfO�C/ATI 7 Q��-//L�`_-_----- /-------. 1l�ffl11Y�-r!' ----'--. 1 -� �✓-�................... Owner's Name.......... ------ 6t-KRlfl----,re�lXIC ---------------------------.......=--------------------------- Phone-----------------------•------ Address---------------------- Mme= ................................................................. ..................--------------------- --L------.....--........... Contractor's Name-- SQe%.: 0Phone, -- ` Installation will serve: ResidenceX Apartment House [I Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _1_--- umber of bedrooms ...Z--. Number of baths .j-_. Lot size - Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table 00 ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adob'eI g Hardpan ❑ Previous Application Made: Yes ❑ No [Y New Construction: Yes ❑ Nox FHA/VA: Yes ❑ No J� TYPE OF INSTALLATION AND SPECIFICATIONS: 1i .(No septic tank or cesspool permitted if public sewer is available within 200 feet.) tic T h Distance from nearest well.................Distance from foundation...:.--_--__..`---Material.........._.-----------...._.__----_----.------- Up No. of compartments:.-------`--------- :_size-----------..... -'-----•---Liquid depth"---'----- ------------Capacity------------------- D' os� ieR�� Distance from nearest well----AvdDistance from-.foundation...44.:.._.Distance to nearest lot lines--5a...._. "� Number of lines__--___....`._^�.__ __.,s Length of each line..... P....�......_.Width of trench._. -S y...................09 Type of filter material....._t�o.C�.._Depth of filter material.... /...._../--_Total length...... Q................ f deep :'/� Distance to nearest/ell--__-�L647-_Distance f�m foundation_ IM----._Distance to nearest lot line_-1</ _ . Number of pits---------...___-- ..Lining material-_--_ _ ate--.Size: Diameter._..�.,�..__.__Depth--_Z,1..__...__.-....1fl r Cesspool: Distance from nearest well.................Distance from foundation--------------......Lining material...................................... ❑ Size: Diameter---- -----------Depth----------------------- --------------------Liquid Capacity....................-'----`gals.0 Privy: Distance from nearest well.___._----._.,-------------------------------Distance from nearest building...................... .......J0 Distance to nearest lot r" - r----- - w-------- ---- -------f- -- li�ne------'----------------------------------------------_------------ _._..r.e.d_.._....-r---------.------------------------------------------ a .F.-----�--!-�-___-......--'I�-.-.....T_- ' -'-i-_ --�- -- Remodeling and/or repairing (describe):_._ _- - - - ---- - � -------- � ...... ...... -.. ------" ' ------------ 0.---- ----- -- --- -------------------------------------------------------.....--------------.........-----•--------------------------------.............---------•----------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County f ordinances, State laws, and r and regulatio�oott San Joaquin Local Health District. (Signed)---- --"... �-'----i�-//LG.i! """�" --------------------(Owner and/or Conkeetor) _------------------- -- - --- L/ -- - - ---------------------- --- BY°----------------------------------------------------------- '- -------- ----- - - ----------------------ode)---------� ----------- (Plot -'- - (Plot plan, showing size of lot, location of system in relate n to wells, Ildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---------------- ------ - ------- -.-------- --------- ----------------- --*.... DATE------------ . ------ - ---------- REVIEWED BY---------'-"----'---'-........... DATE BUILDINGPERMIT ISSUED.--------- -- - ---------------------------------------........... DATE-'- -- -- - -----•------------- Alterations and/or recommendations:.... ... - --"----'--'-'--.--•-•-----------•-••-----------------------I------- ---- - ................... r. -----------------------------------------..........'...........'-'--------------------"'......------------------------------------------------------------------------...................................... ` FINAL INSPECTION BY:- Data ----- - b ............................. .. - . SAN JOAQUIN LOCAL HEALTH DISTRICT 130South AmericanStreet300 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.