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/gyp APPLICATION WFOR SANITATI nDa t No. (Complete in Duplicate) EXPIRES ONE YE5 Issued ____ -._ - -- - FROM DATE Application is hereby made to theSanJoaquin Lb cal Health District for a pe i o cons ruc an ins a e work herein described'. This application is made in compliance with Cou ty Ordinance No. 549. '' ' P j 5------------- -- 1�'b r .-. •--------------- JOB ADDRESS A fl L CATION _� -- � '4 _ �• ---- ---- -'-- ---- '' ----------------- 1 ' - Phone Owner's + - -- Address--a` -- ------------------•--'-'�'--- ----------------------- -----------------"-------•--- Contractor`s Name___ ------------_ ` hone---------- ----•----••-----•----• - ------------ ----------------------------------------------------------------- ` blouse ❑ Commercial ❑ Trailer Court ❑ Motel C3 Other Installation will serve: Residence Apartment' -7 Number of living units: _�._ Number of bedrooms Number f baths _ /� -_.x-.f__ y----------------- __-- Lot size ____-- --� Water Supply: Public!system'❑ Community system ❑ Private Depth t ,Water Table -------- ft. � � Character of soil to a depth of 3 feet: Sand Gravel ❑ Sandy Loam [►Clay Loam ❑ Clay ❑ Adob, r . Hardpan ❑ New Gonstruttion: Yes �No ❑ FHA/VA: Yes ❑ No Previous Application Made: Yes ❑ f'Jo TYPE OF INSTALLATION AND SPEAFICATIOHS'. - b , (No septic tank or'cesspool permitted if pubic sewer is available within 244 feet) �Se is znk: Distance. from'nearesT weir isfane. from foPnda on �� __.__ at i�l _______ _____ _____ p� - l --- --Liquid depth--- -- -Capacity-- U r No. of compartments-_ _ _ - , rze Distance from foundationjaa�_ isfance to nearest lot lines_ ,_ 5`- Disposa/Field: Distance from nearest wel - ____ /I'' ! f ' n tfi of each line------ --- ---- Width of tre ch-__._____ _------- Number of lines-------- ------ g �` --------------=__ ___hbpthType of filter mated L m3- 1 of filter material__________ _____ otal length � _ -___--'-5eepa a Pit: Distance ton Wires istons rom f undation__,._ istanc,g'to Feares lot line______ __________ -Number-of pits . - --- Linin rnateria- --- --- _- 'Size: Diameter----- -- Depth---- --- -=_- Cesspool: Distance from newest well__-------------_Distance from foundation-------------- Lining material------.-------------- --------------- Size: Diameter----------------------:- ---------Depth- -Liquid Capacity----------------------------gals, it y: Distance from nearest well. __. j _Distance from nearest building- -----------------------------Priv _Distance to nearest lot line_ r "`'------ ------------------------Remodeling and/or repa�ring (descr�be�:--_ =-------------- ---------------- -t----------------- ------------------------------------ ------------------------------------------------------------ --- --------------•-----------------•---------------------------------------------------------------------------------------•------------------- --- 1--hereby certifll that I have prepared this application and that the work will be done in accordance with San Joaquin C ces, State laws, a d rules and regulations of he San Joaquin Local Health District. i .�, ordinances, i � --__,_____Owner and/or Contractor (Signed) -- = - ----- -- --------------------- - ( } i r ----- -- (Title) ---- - ------------------------------ ---------- Sy=--------•----------- ------------------------------- --- (Plot plan, showing,size of lot, location of system in relation.to wells, buildings, et canbe placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---Q---- '-------------------------- ---------- ---_--------------------• --- --------------- DATE------------------------------------------ DATE--.Q---------------------------------------------------- REVIEWED BY---- `------------- �— BUILDING PERMIT ISSUED------- ----------------------- DATE g Alterations and/or recommendations:--------------------------------------------------- ---------------•--•------------------ 1 -------------••------------------------------------------------ - .___r--------- --------------------------•---------------- ----I--------- --------------------------------------------------- ---------------------------------------------- t 1 l, C -------------------------------- FINAL INSPECTION BY:=1_ �i� Date= SAN JOAQUIN LOCAL HEALTH DISTR T 130 South-American Street 300 West Oak Street 132 Sycamore Street 814N,orth "C" Street � Tracy. ` Stockton, California Lodi, California Manteca, California Ty. California ES-9-2M , Revised 1.57 F,P.CO. °'