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' permit No.APPLICATION FOR FOR SANITATION P -e ,T (Complete in Duplicate) Yx1Issued f 6a Applica*ion is hereby made to theSanJoaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. r , JOB ADDRESS AND LOCATIO ' --! �'�'d' ' ' `" "' J i- , Phone--------------------------------------- Owner's -... - Owne�'sName ` .. ---- --- Address1 � t -.. Contractor's Name------------- . -�� -----...------•--------- Phone --------- c Installation will serve: Residence Apartment House Commercial ❑ Trailer Court ❑ Motel ❑ Others❑ ---------- Dt Number of living units: -- �5 .- Number of bedrooms _--1-.. Number of baths ---I--- Lot size -- --r1-_ __ ---..1---------•- r Water Supply: Public system❑ .Community system ❑. Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: .Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ . Clay ❑ Adobe � Hardpan ❑ Previous Application Made: Yes ❑ No K New Construction: Yes, No ❑ " TYPE OF-INSTALLATION AND SPECIFICATIONS: I(No septic tank'or cesspool permitted if public sewer is available within 200 feet.] _ : Septic Tank: Distance from nearest well'-�__.--- _Distan/t� fro foundation---�-_o------,mater I:-------_^ '_�_�__'---_-_-- _-- -�•. No. of compartments_..-.`�------------Size__7, �X._ -----Liquid depth-.-_----_ ----------Capacity--��C'a___----- Disposal Field: : Distance from nearest well--- --.Distance from foundation .----.Distance to nearest lot ling- Disposal _ _----. 5Z— Number of lines---------- _- ---Length of each line----.--_ .L?_ -- ----.Width of trench.-.. r ------------------ Type of filter material-_ ---Depth of filter material------ ------------Total length-_- 6-l.�__-_-------_.--_-___---_-- Seepage Pit: Distance to nearest well----------------------Distance from foundation---______-_____---.Distance to nearest lot line-____---_--._- ❑ - Number of pits----------------------Lining material-----------------------Size: Diameter-----------------------Depth 4 r Cesspool: Distance from nearest well-----------------Distance from foundation.__.--------..----..Lining material--------------- Size: Diameter Depth --Liquid Capa ty;*,; .� . Size: ----- _._ - ��•-._,�,� �:�. -fes.. Privy: Distance from nearest well--------------------------•--------------- Distance from nearest building-- -------------------------------------- Privy: ---------------------------'-------- ❑ ,Distance to nearest lot line------ ------------••---------- ------------------------ --- ----------- -- -------- /' -1 ------ - d/or e airin desc ibe ! ;c r Remoc�eling�n P g � - -- -•---- ---•-••-._--- -_4 = =---- 102--- ----------------------------------------------- ----------- ------------------------------------- ---------- -------- - . ---------------------------------------------------- ------- . I hereby certify that I ave prepared this application and that the work will be dont in accordance with San Joaquin County, ordinances, State laws, and rules and eg�lations of the San Joaquin Local Health.16is rc (Signed) _�R/ Acl__,��--- ----__ -�,J-----.--.-[Owner and/or Contractor] (Title] i : _ ;::. ---------------------- ----------------------- By: - _. ._.- - f--� . [Plot pian,showing size of lot, location of system in relation to wells, buildings, etc., can be placed an reverse side). t FOR DEPARTMENT USE ONLY ------------------ APPLICATION ACCEPTED BY-----`--------- = ` ------------------------------------------ DATE-----------..-..--..-----•---••-- REVIEWED BY--------------•--------------•--------------- :.. --------------------------- DATE-------- -----•-------- = DATE. ---- ---- BUILDING PERMIT ISSUED-------_------------- ------ Alterations and/or.recommendations------- -----''--------------------=------•-------------------------------------------------------------- ---------------------- ! I •-------•------------------------------•---------- ------------- -------------------------- l - ------------------------------------ -------------•-------•----------------------------------------- F --------------------------------------------- --------------- - f --- ------ ------• -----• ----------•- ---------- J i FINAL 'INSPECTION BY:.--------` _-- Da :-- -- /fir-- "-------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street $14 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9--2M Revisod W-2100