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46 APPLICATION FOFc.�_ANITATION PERMIT Permit No. .__lo__ _{-- (Complete in Duplicate) ice/ / _ Date Issued !- ti Applica+ion is hereby made to the San Joaquin Local Healfh District for a permit to construct and install the work herein' described. This application is made'in�'compliance with County Ordinance No. 549. JOB ADDRESS AND LOCA 10 -:,_ - Owner's Name-------- ---- - - .• -� ------- --- -----_---------- ------------------------------ --------------- ------------- --------=----- - ---- ------ Phone_ -.- -----��.. Address ---- -------------- Contractor's ------Contractor's Name----- -. -1 5 >'cr`G- --------------------------------------- -- Phone Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _J_--- Number of bedrooms ____v_2Number of baths ----Z_ Lot size ___c7 _- ----------------------- Wafer Supply: Public system 0 Community system ❑ Private ❑ Depth to Wafer Table ___- - _ ff. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe® Hardpan ❑ Previous Application Made:F Yes ❑ No ❑ New Construction. Yes ❑ No ❑ i TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well_____....________Distance from foundation____________________Material____________-_ _ �~ "I" --------------- ----- r ❑ ,No. of compartments- -----Size--------------------------------Liquid depth----------------' ------Capacity----------------------- e' —r `^ Disposal Field: Dis}antfrom nearest well_________________'Distance from foundation_- -__________-----Distance to nearest lot line____.____________ ❑ Number)of lines-----------------------------------Length ofeach line------------------------------Width of trench------------------ ----------------- Type offilter material-------------------------Depth of filter material-----------------------Total length-------------------- --------------------- Seepage Pit: Distance to nearest well-._Yd------------Distance fr mjfo ndation__ld---__..',..Distance to nearest lot line__- ------- J F Number of pits-------j_-_____-___Lining material_._---Size: Diameter-_ -_..........Depth___ 81 Cesspool: Distance from nearest well-----------------Distance from foundation__________________.Lining material_____--_________.-_----------------- Size: Z Diameter-------------------------------------Depth------------------------------------------------------- Li uid Ca acit --gals. Disfance' from st Privy:u Distance to neareselinl _- ----___ Distance from.nearesf building tlote_ _...�' ------------------------- 444 k Remodeling and/or repairingdescribe : �� m ---4__�__ ------- :rl--------------------------------------------�11 _________ ______________________________ ----------------------------------------- ------------------------------------------------------------- ----- ______________ ------------------------------I--------------------------------------------------------------- ----------------------- -------------------_----------------- -------- -------------------------- ______________________________________________________________________________________________________________________•_____________--_____--.______-_-______._-_-__________._____-__-___-_____-__-___--_____._--_-.____.__-_ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Sfat aws, n4_,jules and regulations of the San Joaquin Local Health District, (Signed)- - - --(Ownerand/gr Contractor) : (P.lot pian, showing.siz of lot, location of system in relation to wells,�buildings, etc., can a laced on raver p se s+de). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------T -----•-------- - - ---•----------- DATE-- ---------- REVIEWED BY ----------- DATE ---------------------- --------------=------------------------- ----- --— ---------------------------- BUILDING PERMIT ISSUED - ---------------------------------------------------- DATE-------------••- AI rati sand/or recommendations -- - ----- ------------ �. F p_f ��f - - __F •-_ --____----__ - __ _____________ ____________________________�.___'_-._-_____._- ..______.____-- -______. _________________]-__ __-.____.___-- _____________ A. ______._____--_____.______ __________________________________i:..._ d' FINAL INSPECTION BY:__4F-.....----- --------�-- ( � -- - ------------=------- Date_ 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 ; • Ravised W-2100