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—p d 1 ir`' Permit No. APPLICATION FOR SANiTAT10N PERMIT {Complete in Duplicate} Date Issued ._-.f""-- Application is herebyimade to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with Coun y rdinance No. 549. 1 — 2-t D (P f l5( A) C ' JOB ADDRESS AND LOCATION___ � - - � `- - -- --""-�""--�""� f f ! ,----- ---------------------------------------------------------- Phone ' Owners Name------ --- - -- -- - - Address..------ h -"--------------- ------------------------------------------------------ • y Contractor's Name--• tom[ --- -�---- a---`----------- --------"---- --- Phone.--��------�-�- Installation will serve: Residence Apartment House 171Commercial 0Trailer Court ❑ Motel [I Other ❑ Number of living units: __/____ Number of bedrooms _V--" Number of baths . ___ Lot size ____�, r x--1-Lt-d- ------------------------ Water Supply: Public system ft� Community system ❑ Private.❑ Depth to Water Table -,1�ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ San''r1y Loam ❑ Clay Loam ❑ Clay XAdobe❑ Hardpan ❑ Previous Application Made: Yes ❑ Nog New Construction: Yes)6 No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) / v + Material ---- •---------------- i Septic Tank: Distance from nearest well -t�__"Distance- from foundation___ ______..___. �y No. of compartments------.:--------------Size__ _ _. .-�?'--------Liquid depth----- -r------------Capacity-- CL Q p IZ- Disposal Field: Distance from nearest wel -"Distance from foundation-_ ----------Distance to nearest lot line---,c1�.._______. Number of lines----- --" -----------Length of each line------ -A ---------------Width of french......P—Y_' ---------------- Type of filter materiaL__l �/�1i.-"-Depth of filter -------Total length_-__ �j _ r . r f Seepage Pit: Distance to nearest well. ----Distance from foundation___.c`�ff_____-__ Distance to nearest lot line____ ___________ ------------Number of pits;_._.___"---_" ---Lining material--- f---.Size: Diameter------ ---- Depth - Cesspool: Distance from nearest well----------------- from foundation--------------------Lining material__.__ ❑ Size: Diameter-------------------------------- ----Depth-------------------------;------------------- ------Liquid Capacity-- -------------------------gals. 4 Privy: Distance from.nearest well-------------------------------------------------Distance from nearest building______.___.__----_______-_----.- ------ ❑ Distance to nearest lot line ---------------- --------- ------------------------- Remodeling.and/or repairing (describe)---------------I---------------- ------------------ ----•---------------------------------------------•----- • ----------------------------------------- --••--------------------------------•----••-------------------------------•------ ----------------------------------------------------- -------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. P or Contractor ------------------------ ) II {Signed}---( -�f' - ----- - ----•- -- -------- --------� "'------ ---------------------------------------------------------{Title)- --------------------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). 1 FOR DEPARTMENT USE ONLY 'APPLICATION ACCEPTED BY- ----------- ----------------------------------------------------------------- DATE- -------------------------------------------------- REVIEWED BY DATE— BUILDING PERMIT ISSUED-------------------------- - -------------------------------------- DATE------------ . --------------- ---- and/or recommendations-------- -- ---------------- -----• --••----••---.....------••-"-•-------•-------------------------- ------------------------------------ -------- ------------------------------------------••--------- T ---•---------------------•-------------------------------------- j - ' / ..� . ¢f fa ' Date -- FINAL INSPECTION BY:------------ ` _._._" SAN JOAQUIN LOCAL HEALTH DISTRICT # 132 Sycamore Street 814 North "C" Street E30 South American Street 300 West Oak Street Y I Lodi, California Manteca, California Tracy, California Stockton, California ES-9--2M 10-52 Revised W-2100 J z c