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. r AePLICATION FOR SANITATION ��3 7 PERMIT Permit No.o'_.:: _`; -� 41— (Complete in Duplicate) " /! �3dQ�Date Ism ed-0 _.2 _.?.i Application is hereby made to the San Joaquin Local Health District for a permit to constructp%?,s�ll the work herein described This application is made in compliance with County Ordinance No. 549. JOB ADDRESS D LOCATION._-_-_ Owner's--N---a--m------------- 4 -------------- --L- -- A rens0------------- ----------- Phone-_ :_ Contractor's Name--- ------ --------------------------------- - --f- Phone---"- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court 11 ❑ Motu ❑ Others[] Number of living units: _--.i_"_ Number of bedrooms _-� II -- --- Number aths .--fy-__ Lot size __1_42_() � �-�-� Water Supply: Public system -�------ - pP y Y ❑ Community system Y Y ❑ Private Depth to Water Tablft. ij Character of soil to a depth of 3 feet: Sand � Gravel ❑ Sandy Loam Clay Loam ��yPrevious Application Made: Yes ❑ Adobe❑, Hardpan ❑ ❑ . No New Construction: Yes [�No ❑ - 1 TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public selwer is available within 200 � feet.) Septic Fank; Distance from ' 1 nearest well--- Dista effro foun i n---- F [ !° Mater a�4 d`l ,i•,_-t a No- of compartments____________ Size- - Liquid dept ------- ,.--Ca Capacity---- s Dispo 'I Field: Distance from nearest w II. C �} r4 p y ` r -Distance from foundation___ f Disfdnce to nearest lot lin w Number of lines__-___--,_ f �___ y ��77 ---------- - Length of each line--------- __ _, Width of trench---" I Type of filter materi _ - f ltpth of filter material-_-----�[_ -_ _ Total length._._____f�{/ Seepage Pit: Distance to nearest Weil---------------------- from foundation-_-_ ❑ Number of pits-__- ---------------.Distance to nearest lot line_.-__"-_--___".- � ------•----------Lining material-----------------------Size: Diameter-----------------------Depth -- ❑p Distance from nearest well-----------------Distance from foundation--------------------- material_-------_---_-.____ 1 Size: Diameter--------------------------------------Depth--- q Capacity--------------------------•--Sats. 4i ------------------------Liquid Ca acit .---•--------- Privy: Distance from nearest well---__-_"--_.-___ _ _ _ Distance from nearest buildin ❑ Distance to nearest lot line------------------- I ---------------------------------------------- -----------------•----------------------------------------- Re o e ing ,a6d/or repairin�' (descri ):_ -_-- "s ---------------- � -------------------------- ,.k._ --- ------------------- -. -------------------- ------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed)--'e -- - ---- By: "/ - ---------------------------------------------------- ---Owner and/or Contractor -------------------------------------------------------------- -----(Title) r (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc.; can be placed on reverse side). - - - ------------------------ I FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-- ------------_---_ - DATE__ REVIEWED BY ------------ BUILDING PERMIT ISSUED__-- ---------------------------------------- DATE-__ ----------------------- --------------- - ----------------------------------------------- A tare+ions and/or recom endations: __- A - ----- D TE -/ ------- ------------- - = ------ = --- --- _ --------- 1 ' .------ - ----�---------------- ------------------ -- - -------------------- -------------------------------=------------------------------ ------------------------------------ ----------- - --------------- - FINAL INSPECTION BY:-_____"___---_.-_-.-_-------------------------- �f ...... W ' 4) �. ----- Date - {-J,�* -------------- --------- -------- SAN JOAQUIN LOCAL HEALTH DISTRICT y�� Yf�� 130 South American Street 30U West Oak Street Stockton, California 132 Sycamore Street 814 North "C" Street Lodi, California Manteca, California Tracy, California ES-9-2M 8-51 Revised W-2100