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S�APPLICATION FORySANITATION PERMIT Permit No.Duplicate) n i d (Complete .. Date Issued ---- A J i trict fora ermit to construct and install the work herein described. Applica+ion is hereby made the San Joaquin Local Health District p pp mpliance with County Ordinance No. 549. This application is made in co JOB ADDRESS LOCATION__-t-------- -- ``. -r`3 -_4__`�_. � _ .� _# ---------- ---------------�j------------ -- ------ Owner's Name__ .. _1 'h '. i� _ a. L?---------------------- -------------------- --------------- --------------------------- Phone -�`L- Z .c�- ---------- --------------------- Address----- _.. Contractor's Name,--��Q-------------•--------------- _ Phone `t- Installation will serve: Residence ❑ Apar#ment House ❑ Commercial d Trailer Court ❑ Motel ❑ O�her ❑ Number of living units: .1 El Number of bedrooms _------- Number of baths -___..__ Lot size _�s C�____________________________._ : LL " 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 ❑ ili L Previous Application Made: fes ❑ No New Construction: Yes Ba"No El TYPE OF INSTALLATION AND SPECIFICATIONS: il (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well-___-._._-----.Distance from foundation--------------------Material------------.------------------------------------ No..of c„'mpartments-------------- -----------Size----- ------------------- -----Liquid depth------------ -----------.-Capacity---- ------------------ Disposal Field: Distance from nearest well.................Distance from foundation--------------------Distance to nearest lot line-----------....... �y Number of lines----- -----------------------------Length of each line---------- -------------------Width of trench--------------------------- :------ u Type of filter material---------- --------------Depth of-filter material------.------------ _-.Total length---.----_-__--_-.---______________�____._ Seepage Pit: Distance,`o nearest wel� _-- ---_--Distance from-f, dation_ ___ __.DLssnce to nearest lotne____ _ ______ Number of its._ ---_--Liniri material____:_.. _ . . Size: Diameter--_,0__---__.__-.Depth-------------------------------- Cesspool: . --�___________________ I pits--i g 4 , I Cesspool: Distancefrominearest well-._-.-----__-__-Distance fronQ foundation------------------- Lining material------------ -- 171 Size. Diameter----- - -------------------------- Depth-------------------------------------- ------------Liquid Capacity—--------------------------gals. � Privy: Distance from nearest wek-------------------------------------------------Distance from nearest building-----------------------------------------. Q ❑ Distance to nearest lot_line---------------- ---------- -- -------------------------------------------------------------------------------------------- Remodeling and/or repairing cribe):--_ _ y � ------------ _(des i (3 'yu ' -- - =--------------- 1------------------------ --- ------------- 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. !r (Owner Contras � -- ----- •---------- --- �----------------------------------------------- - - ---------------------------- -------------- ------------- ----IOW and/or tor) (Signed)..___ __ l - ----------------------------------- By:......... _ ------------------ •------------------------------------------ ------------•------------- -------------(Title) ��1 - (Plot plan, showing ze of lot, to ation of system in relation to wells, buildings, etc., can be placed onver;e side). FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED;BY --------y ----------------- ----------------------------- ------------- DATE--------------- --5�------------------------------- REVIEWED BY----------------------I - DATE------- -/- --------------------------------------------- BUILDINGPERMIT ISSUED-iM'--------- --- -------------- ---------------------------------------------------------- DATE--------- ------------------------------------------------- Alterations and/or recommendations------------------------------------ ------ -- ------ -----•--------- == - --��------ .------ -. __ - 7 ” f� � -- -------------------------------- --------- I FINAL INSPECTION BY:-M' -------- --------- Date - ---------------- ----------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT a - 130 South American Street 300 West Oak S+ree+ 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9^ZM 145446 ATWanD IZ-54 �I