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R SANITATfOA Permit No. c • APPLICATION FOR I h4 (Complete in Duplicate) �pp�� Rf a.#` Date Issued -�-�- l\? . and install the work herein described. Applica+ion is hereby made to the San Joaquin Lacal Health District for a permit to construct is application is made in compliance with County Ordinance No. 549. + L. ---------------------------------------------------------------------------------- JOB ADDRESS` D LOCATI N__"" � __-- -- ��"" , � �-' ------------------ Phone Owners Name...... - -• Address ---•... ------------------------------------- ------•------------------------••-------..-.------------------------------ ------ j--- [-- --- Contractor's Name-------X------ -.._-. ------------- Phone.--- - Commercial Trailer Court ❑ Motel ❑ Other F❑ Installation will serve: ''Residence � Apartment House ❑ ❑ ! � `�.d� 7\---`fie--Gl Number of living units: _".' 1�umber of bedrooms ""- Number of baths .--".."" Lot size _"".______-" ___-- Water Supply: ➢Public system 021--c-:0mmunity system ❑ Private ❑ Depth to Water Table Character of soil to a depth of 3 feet: Sand ❑ , Gravel ❑ -Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe[ --Hardpan ❑ ' Previous Application Made: Yes ❑ -No ❑---_�ewtConstruction: Yes ❑ No .❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) nk� s4 Distance from nearest well-----------------Distance from foundation-_---_- -----.Material--------.--------------- ---- Se ti a No. of compartments ---------- ----Size---------------------------------Liquid depth.;---------------- ------.Capacity--------------------- Disposal Fiel2i: Distance from nearest well-----------------Distance from foundation--------------------Distance to nearest lot line--_----__"`"" .� Number of lines------------- -------------------Length of each line------------- ------- "-.Width of trench_-------`------•--------------• Type of filter material------ P r material----- ------Total length-------------------------------------- ----------------- Distance to nearest well` Distance�from� - ' "_-"Distance to nearest lot ------.-De th of filter ""_ �' foundation"" Seepage ,, " ® Number of pits....$_.".-----------Lining material-__ '-------.Size: Diam ter----- ----------------Deptn"_______------------------------ E Cesspool: Distance from nearest well-----------------Distance from foundation_'..---.. .Lining materia4--------"""--------------"___"_--_--. ----De th--------------------------------- '.----------------Liquid Capacity------- -------------- gals. ` ❑ Size: Diameter" --- ------ --------- ---- - P " Distance from nearest building----------------------------------------- r'rivy: Distance from nearest well---------------- ------ f _.. _ -------------------------------- ❑ Distance to nearest lot lire--------------------------------------------r----------------' �. .. • �..� .1-- --- ---- - - --- ----------= Remodeling and/or repairing (describe):"-__ ------- � '"" -------.1----------------- ------•------------ -- --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ;, I hereby certify that I have prepared this application and that thework will be done in accordance with San Joaquin County 'f ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. ` (Owner and/or Contract Si ned -- ------------------------ d/o t ig )--- --- l --------- ---------------------------------- I �1" h.f14�l(h.c ------------------- -------•---------- ---- IY•----------- - --- r (Plot plan, showing six f lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY I APPLICATION ACCEPTED BY------ ---------------------- - --- DATE- --------- *E ------- ��r� REVIEWED BY ----- -- DATE-------------- BUILDING PERMIT ISSUED---------- ------------------------------- ---- ------_ DATE } i Alterations and/or recommendations:------------ ----- -------------- V_ ' = 1 i_--_5: _ � . . - . •!.&------------ -------------------------------------------------------------------------------- I i Y r-►a�a.- -- = --------------------------------------------------- --------------- ----------------- -------- --------------------------------------- ---------------------------------------------- r- -'-.-"----------------------- -------------------- -- � a �------------------------------- }FINAL INSPECTION BY:-_'Z_ J--------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 300 Wast Oak Street 132 Sycamore Street 814 North "C" Street 130 South American Street i Tracy, California Stockton, California Lodi, California Manteca, California y. E� � 145446 ATW[1 Clo +�-