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APPLICATION FOR SANITATIQN PERMIT -v Permit N ( M (Complete in Duplicate) 7 . Applica{ion is hereby # ""' '�-� Date Issued '___] y made �o the San Joaquin Local Health District for a permit to car, ct and in This application is made in compliance with County Ordinance No. 549. ^ stall the work herein described. JOB ADDRESSu D LOCATION Owner'sName > _sdM -h1_. ------ Address •-- - .. �." rl r'-S ------ ------ �"�-�---�--•�.------ -- -------------- Phone"-_.----- d -�-�-- Z ---------- --------------------- Contractor's Name-"-- _-__�} � R f �• t� r• L -----•----•- -• instaAation`will serve: •Resid�p ce / C a s. ------------------•------------------------ Phone _ Apartment House U Number of livingunits,__ ❑ Commercial ❑ Trailer'Trailer:Court-__ Number of bedrooms,%.3 ❑ Motel `�--- Number of baths __-- � --------- ❑ Other [] Water Supply: Public system1 Lot size ._�A, - qq ❑ Community system. - -•--------- --x--- �:�-•------ Character of soil to a depth �� 3 feet:t Sand ❑ Pnvafe C!•`Depth to Water Table.f d_ ft. Previous Application Made: �M s ❑ Gravel ❑ Sandy Loam ❑ Clay Loam _� t ❑ Clay [( Adobe ❑ No [ New Con_struction: ..Yes:C No ❑ R3---Hardpan ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic fan.k or cesspool permitted if public sewer is available within200feet, ;# Septic Tank; Distance1frm nearest welt"-" �� 1 �p --.Distance _f-9.W foundation_--l_ ----O ❑� No. of compartments----- .-__ „ ----'Materia!-_ _� 49 /�/`C Disposal Field: sZ---------- Size °r;- _� Liquid depth'- Pi 6__.3 '� p Distance from nearest well-- %��i�FDistance from foundation--"�-Q , (Dist ---Capacity---Fe" t.. Number P bar oflines-_-__-_-_-_ _ ante to nearest lot line--1'O-� `-3 i,--------" en theof each line-3 0 " p L g / -5f,- *;�-Width of trench-------;� –i� J`_- =Depth of filter material--".-/�j ! � Seepage Pit: �l Distance to i nearest-well'_- - ----- Total length-_--_�,,,��- Type or i t�ryryr material__-" -_-2_ � r_ .{ I EQ--d---"-_-Distance from foundation_--_�ts number of its-------- ------ .Distance to nearest lot line-_"!0_ r p ---""--- Lining material._'►'Z K--_ Size: Diameter_--. �� Cesspool: Distance frpm nearest well _ _-_------_ •�• -Depth- -3 -�_- , "Distance from foundation-------------€__--Lining material_--.-"__-____---" " S ze: Diamet r ------ ---"_'--------------Depth---------= 1 ------ Privy: ----- I -------Liq f . Distance fr'4� nearest well_'"^-"------ u d Capacity---------------------------- s. - ,. --- -----------------=------Distance from nearest building.- "` Distance to �earest�lot line"-=_--_--=- � _-"-_ y _�. Remodelin and or rej airin describe:-- - + � ----------.-•-- - ----------------- --- ------------------------- -- ----- :----------------------------------------•-----------------'--------- + ----=--•------------------•± 1 - -M�---•- ----•--•-------------------------------------------------•1-----------------•--•---------------- --------------------------------------- r ! hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin Count ordinances, Stat s, and rules and regulations of the San Joaquin Local Health District. q Y (Signed•._--- _- ----- era ------- --- / C - t Y = and/or o ct (Title}." � ---------------------------------- (Plot _____ ___ d o ntra orJ [Plot plan, showing elle of lot; 10 tion of system in relation to wells, Buildings, etc., can be placed on.reverse sid 1 $�• i �� ' '� FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-_-- " REVIEWED BY------------ '�� = ------------------------------•-------------------- DATE--- --PERMIT ISSUED- �� - - DATE _ Alterations and/or recommendations: - --- ti-------- ------ ------ DA -------- - 4 - TE - - �` - - -------- ------ ------- --- - -- --- I ------ FINAL INSPECTION BY:--------------- _ ----- ate---=��-----= ----- t --------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street j j 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California I ES-9-2M ; - Revised W-2100