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'WAPPLI CATION FOR SANITATION - .RMIT Permit No. (Complete in Duplicate) Date Issued ,_f"3�'� _)--- Application is hereby made to the San Joaquin-Local Health District for a permit to construct and install the work herein described. This application is made in compliance ith County Ordinance Na. 549. JOBADDRESS AND LOCA` N _ __r" - Owner s Name_-- -- ----------------- Address. -`-- ------------•-- Phono" Contractor's Name------- a -------- -- ------------- _ c a e-24�; ----•----•-------- Installation will serve:� Residence ❑ 'qXe ment Hous ❑ Commercial railer Caurt Nurrmber of living units:�� Num ro ms __-_-__: Number of baths Water Supply: Lot size ___----"""--__ PP Y� Public`system"❑ 'Communifi system ` i f = Y Y ❑ Private �epth:to Water'Table ��_ ft. "r• � Character of soll to a depth of 3 feet: Sand ❑. Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay Previous Application Made: Yes' .. Y ❑ Adobe�ardpan ❑ ❑ No:�New`Construction'�'Yes ��o � FI-iA�VA: 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 --Distance from f u dation--- Mafi e,&- ; �,� No. of compartrnonts_.__ f - ------------ Size r--" __, _._,.Liquid d pth_--- � Capacity-J~ Disposal field: Distance from r�eares well/%:?AO_o--Distance from foundation_ __ A Number of lines___" r -- - -----.Distance to nearest I t linea'^, . Length of each line____ Type of filter material L W----------------Width of french------ -�� -- ---_---Depth of filter material_- -_ "/ ti �if Total length- ____ Seepa it; Distance to nearesjwell_-_ ;; _ Distance from fou dation_ 0__-`' � � (�� Number of pits-_s7 j ---.Distance to nearest lot linesr ' ---------------Lining maferia��__.4ZSize: Diameter__ •r -- ----- Cess Cesspool: - ---- ----Depth•-4`_`' p Distance from nearesf well------------------ ________--____Distance from foundation--- Lining material___""_"- ❑ Size: Diameter---- ----------- -- --- Depth----- ` - = ' -- -- ------Liquid Capacity Distance from nearest well'----------__%-------- _--" --- Privy: -------gals. = Distance from nearest buildin ❑ -Distance to nearest lot line.-�-_�------=�--_�-"",. 4------:--------------- Remodeling and/or repairing (describe): ; ry ----� . __.__-_. __________________ -________. hereby certify that I have prepared this application and that the work will be done-in accordance with San Joaquin County ordinances, State laws, a rules and re ations of f San Joaquin Local alfh District. or ina rJ (Signed)- ----------- - . . --- --- ----------- ------------------------------------- By: - -BY=--------------------------------------------_ k Contract or) (Title) Plot plan, showing size of lot, locati f system in relation to wells, buildings, etc., can be placed on re se side). FOR DEPARTMENT USE ONLY —� APPLICATION ACCEPTED BY_-__:i -tiREVIEWED BY-------------- _ -------------------------------------------------------- DATE-- ---- ---- --------------"-- _.BUILDfNG PERMIT ISSUED - --- -- - -- --- S G- • / DATE----- Alterations aWor re mmendafio __--- --- D = -- �- -------- --- --- --------------- ----- - ------------------------- -------------------- --------- -/--------------------------- -------- =. == - ------- ---- - --- V ----- ------ --------------- FiNAL INSPECTION BY:_ Date = ------------------- 4 SAN JOAQUIN LOCAL HEALTH DISTRICT k 130 South American Street 300 Wes} Oafs Street1. . a ` Stockton, California 132 Sycamore Street' f_od814 North "C" Street Lodi, California Man}eea, California Tracy, California F$-9-2M . Revised 1-57 RPM.