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OR SANITAJION PERMIT � �Permit) No APPLICATION F (Complete in Duplicate) Da+e..lssued ----- ---- - for perm to construct and install+he wo rk herein described. APplica}ion is hereby made to the San Joaquin Local Health District P ai� q-z1"0 -oG County Ordinance No. 549. This application is made m co., P -" . --- + • withLAN m fiance RL ADS p O ATION _ -- - ° ". _,__ cif ., ! c • ' ` - fir JO _ . ` -• -- - Phone'.--•-- " :. --------------•------------------------ -------------------------- II --•----•--•---•-•--•- Owner's Name-: 1V1. . "�' �� - #"... �`` __"1.�.- ___ -� Phon�� AA •-•--------- i Address------------------ ---------------------------------- ----- - -------------- Other ❑ Contractor's Name__ �_�'��------•-_--_',"/""-•""----"""""-- Trailer Court ❑ Motel ❑ Apartment House ❑ Gommerual ❑ Installation will serve: Residence lJ AP F � 1t-t ,.� ' T ,,�_"-- Number of baths �-, Lot size _-- - -- --- - f ---- Number of living units: -------- Number of bedrooms - private [Depth to Water Table "_a�.��t• �I Water Su 1 Public system F1 Community s stem ❑ Adobe❑ Hardpan Gravel C]PP Y� Sandy. Loam Clay Loam ❑ Clay ❑ Character of soil to a depth of 3 feet: Sand ❑ ❑ A �. Previous Application Made: Yes ❑ No 21,11' Nem' Construction: Yes 0 No El TYPE OF INSTALLATION AND SPECIFICATIONS: t ..� (No septic tank or cesspool permitted if public sewer is available within 200 feet.] / * / I PCa acit FO D- t'� Septic lank: Distance from nearest well___"-��-- --Distant,from�undation_".,.I�-.-------.Materia!_:"�_"__• .�a---_---=-•------ ----• " P Size ' ' 'Y- _,Liquid depth.----- ----�"------ � p Y f No. of compartments---------- ----------- �. l Dispos Field: Distance from nearest well --:-- --Distance from foundation_"-="" -f...----Distance tt nearest dot linfi--------------"-__ Number of lines - tof fslter ma ria .A -------Total length I- --------------------- _ -_ -----Len Length of each lin AP-17 �- - -Width of tre TYPe of filter'mferial-_1-,�y Depth Distance from foundation --------------------- to nearest lot line----------------- � Seepage Pit: Distance to nearest well----------- ------_- - Dt th--------------------------------- ❑ Number of pits----- =---------- Lining material------------:----------Size: Diameter----------------- i�P N Cesspool: Distance from nearest well-----------------Dep+ince from foundation.--.--- --------Lining mafer Capacity- gals: Size: Diameter ..: e ' - = --- -------Distance from nearest building_ , Distance from nearest well- _-- -- - ----------------------------------------- Privy: ""---""---- "-- ---------•--- ❑ Distance to nearest�t'line_"--__"-__"_-____ �I - ---•---------------------- r Remodeling and/or repairing (describe)--------- ------------------•---------------------------- S ---••-------- ° - ----------- ----------------•--------------------------- I. -------------------------------- . ♦ r F - t ----------- III -------------------------------------------------------------------------------------------------------- -----------------------------• ---------------------i------------------- hereby certify that I have prepared epare regulations i off the San Joaquin Local kHeai heDitr ctdone n accordance with San Joaquin County ordinances, State laws, and rules a 9 • ` i (Owner and/or Contractor) ' --------------- _0.. �` ------------------------ �I (Signed} ~ '`h""" 1 - ------------------------------------------(Tit) •" s -- (Plot plan, showing size-of•lotjldcation of system-in relation to wells, buildings, etc., can be placed on rev erse si e). -'"FOR,DEPARTMENT USE ONLY ------------ A ---- -----•-------- `------ DATE--�----- ------------------------------- APPLICATION --------------------------- APPLICATION ACCEPTED BY �' ----��--------------------------------- - - - DATE-- -- ----- ------------------------------------------------ �" REVIEWED BY - DATE.------ 4` 1� BUILDING PERMIT ISSUED--------------- -t--- ----------------------- -------- == :.."_... ---------- Alterations and/or recommendations:""- �, ------------ --------------------------•-- ..,,, ---------------------------- I� ----------------------------------------------------------------------------------- --- ------•------------------------- -- - -----•----•----- ---------------- / a Date-"�_:'---- FINAL WSPEC710N BY:-.-':-------- SAN JOAQUIN LOCAL HEALTH DISTRICT J J l 132 Sycamore Street 814 North "G Street 13o South American Street 300 West Oak Street Tracy, California Stockton, California Lodi, California Manteca, California I --