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: -77v- '5 7 - s ~"Y4J- TAPPLICATION =POR SANITATION PERMIT Permit No. ,, ► .r {Complete in Duplicate) 3 J" Date Issued . _ d_. Applica}ion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work here 0 scrib�. , This application is made in compliance with County Ordinance No. 549. /I . �S --- �.----------- JOB ADDRESS AND LOCAT N._._____ ____Q--f�`==�-------- `- - RR � �- (�; �`—----------- Phone_`?=_1, C. ....... Owner's Name---!-- _ _'.------ - --- -- - ------- ----- --------- a 9 .1 ---------------------------- --- ------------------- ----- .. Address------------••/6----- ------•. -- - Contractor's Name------ - '------------------------------- -----------•-----=------------------------- Phone- J Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court [3 /Motel ❑ Other F]Number of living units: ___ __ Number of bedrooms -3--- Number of baths j--- Lot size ____I--s�---__ --_ ______________________ Water Supply: Public system 11?-tommunity system ElPrivate [IDepth to Water Table . d ft. Chap ratter of soil to a de th of 3 feet: Sand Gravel [_1Sandy Loam ElClay Loam [IClay ❑ Adobe Hardpan❑ Previous Application Made: Yes ElNo New Construction: Yes lk/ o ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: ! (No septic tank or cesspool permitted if public sewer is available within 200 feet.) 01-1 Septic ,ank: Distance from nearest well------�S___Distance�from foundation------L _.______.MateriaL_1:___ __�� ---- No. of compartments_._____._ _Size_ .Capacity__.., �t Liquid depth-_-- �------- ----------- Distance to nearest lot line-__nQ__R_:- Disposa Field: Distance from nearest well-----k7-d. ._'Distance from foundation------ _ \ ( Number of lines_____________�__________________Length of each line_______ d-�--- Width of tre . __ --------------- � Type os filter material_ / _---.__._.___Depth of filter material____._��_._ Total length-------- Q_____________________ + Seepa Pit: Distance to nearest well--- ____Distance from ou dation___.__yQ__:_-__.Distance to nearest lot line___`�`�� -_ 4 � -Size: Diameter--------- -- Depth r s � ,� Number of pits-------_�------------Lining material_�.�.-_-- --_-- p Distance from foundation____________________Lining materia l__._-__.-__________.__.______________. Cess❑oolc Size Diameter nearest well---- --�:-Depth------------------------------- -------------------Liquid Capacity-----------------------------gals. Privy: Distance from nearest well----------------- -------------------------------Distance from nearest building____---___._______________-------- . .�.._, ❑ Distance to-nearest lot fine =--- '� ----------------•--------------------- ---------------------------- Remodeling-and/or repairing (describe)------------------------------- ---------•--•------------------•---------------------------------- •-----•--------------------------------------------------•-------------------------------------------- ------•----------- f ----------------•-----•----------•---------------------------- ----- - - ----- ------- -----•-- ------ --•--- ----- ------ 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'Jaaquin Local Health District. (Signed)----------------- -------------------------------------------------- -------------10#mw and/or Contractor) -- By=--------------- ------ -• -------------------------------------------•----------------'----(Title)---- - ----------------- y (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY - �s1 ------------------------- DATE 7 ------------------------ -- Y REVIEWED BY-------------------------------------------- ------------------------------------------------------------------- ----- •---- DAT BUILDINGPERMITISSUED------------------------------------------- ----------- --------------------------------- DATE-------------------------------------------------------------- Alterations and/or recommendations--------------------------- - -•-••-----------•---...-.------=---•------------------•------•--- ---------------------------------- ----------. , - -----•------•--------- --•-------•-•------------ �" }, - - . F -- - rq FINALINSPECTION BY-=--------------- ---• -------- Date-------- --------------------------------------------------------------•---- SAN JOAQUIN LOCAL HEALTH DISTRICT r 130 South American Street 300 West Oak Street 132 Sycamore Street Bio North "C" Street Stockton, California Lodi, California manteca, California Tracy, California t ES-9-2M Revised W-2100 r