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APPLICATION FOR SANT ATION PERMIT permit No. ? 3 .--- - •[Complete in DupYcDate Issued ----- mit to construct and install theate]- a Lica+ion is hereby made to the San Joacluin�Lccal Health District for a perk herein described. This application is made,in compliance with County Ordinance No. 549. S N- h•4;d,a+� c. �- ----- ;,dX6 d',... ... ... JOB ADDRESS AND LOCATION- rlo.C7�0 -- - -------- Phone � �_, Name------------ { ........ a - ---e-- - -- Phone_Address--------------•---------- ------ -- . r _Contractor's Name_________________ Other Installation will serve: Residence `Apartment House E] Commercial ❑ Trailer Court rooms, -. E3 Motel ❑ " r Number of baths �--- Lot size ____- f Number of living units, -1----- Number of bed De th to Water Table ruz_- ft. Water Supply:` Public system C1 Community system [Private ❑ p Clay Loam ❑ Clay ❑ Adobe��F�ardpan ❑ Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Y ious Application Made: Yes F1 No t' New Construction: Yes ❑ No - 1 Prev PP TYPE OF INSTALLATION AND SPECIFICATIONS: (No ptic tank or cesspool permitted if-public sewer is available within 200 feet.)let' ' ------ .Matefia`_ - -- ' s "_ Li uid de th_.'� Capaci#y.- ------ Septic Tank: Distance from nearest weal__,- ---Distance om foundation__.- - No. of compartments-.__ ----------- S-ize < q P, ' �Distance from foundati n ----------------Distance to nearest let line-* ----•-• Disposal Field: Distance from nearest well___ rT -- Width of french------ -- , Length of each line----- ---- - ------------------ �•� Number of lines_--------�--- g _ ��`,Depth of filter material------1 ---------Total leng}h------••�--- •-�-----•---------`_._ Type of filter material___ ¢ (�`Distance from founda#ion____f, ____._-..D to �e to nearest lot line--a____.------ De Dept a Seepage Pit: Distance to nearest yywell_._____.J --- y ize: Diameter__ ."_---- - p Number of pits___. C------------ Lining materia Distance from nearest well from foundation-------------------Lining Capacity------------------ ------ - ------ 9als. � r r Cesspool: Depth------- ----------------------- ------------------- q p Y--------------------------- ❑ Size: Diameter------------- ------------- ------- Distance from nearest building---------------------------------- ------ Privy: Distance from nearest well.-------- ------- ------------------------------ n ---------------------- •--------------------------- ---------- it Distance to nearest loft line.__."_--_-`------- ---------------------------------------------------- --- - � ❑ ----•------• Remodeling and/or repairing (describe):-- --- - -----•--••----------- ----- ---------------------------------------- ------------ --- ------ - - - --------------- ------ ----------------------- - I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin Courtty l District- ordinances, State laws, and rules and regulations of the San Joaquin Local Health Dis+ric+. I �� wrier an Contractor) S . .y ----------- --(O d/° {Signed]--------`--"= T W. By------------------•------- ----------------------------------- � -• [Plat pian, showing size of lot, to ion of system in relation to wells, buildings, etc., can be placed on reverse sid • � ". FOR DEPARTMENT USE ONLY -------- --------------- ---------------- DATE-------- ------------ APPLICATION ACCEPTED BY DATE--=----•----•----------------- REVIEWED BY----------------------------------- ---- - ---------------------------------- DATE. ------------------- ------------ BUILDING PERMIT ISSUED----------------------- a = . Alterations and/or recommendations:__ _. __ -- r ' .._ �jp�.(} _ ___ ________________________________________________________________________________ __ ----------- - ---------------------------------- _ -------------I__.--------- ------- _._--._.____"_________ ------------- - • ------------ ��, Date----- - --- --- - FINAL INSPECTION BY:__:__ ----------- ----------------- � - - SAN JOAQUIN LOCAL HEALTH DISTRICT r 132 Sycamore Street 814 North "C" Street 130 South American Street 300 West Oak Street Tracy, California Lodi, California Manteca, California Stockton, California - ' EoB_ —2M 145446 ATWnDD 12-54