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PLICATION FOR SANfTATION PERMIT Permit No. (Complete in Duplicate) " I - Date Issued. -- ��- Application is hereby made to the San Joaquin Local Health "District for a 549 This application is made in compliance.with County Ordinance Nopermit to const utt and install the work herein described. . . JOB ADDRESS AND LOCATION -aC �. l �`-- / ,�---- . - ----- Owner's Name---:_- ._. - _ --- ---- -- - -- .. 1r--�. �f,... r,..� -------- _ Address -- ------------------- Contractor's ------ Q- ------------ - fT. Confiractor s Name -.----- ; Installation will serve: Residence ---._------_cial____-- ---------------------------------. one.__ 1 ❑ Apartment House --•----•-•--•----•--••--•---•-- ❑ Commercial [] Trailer Court p Motel l Number of living units: --__Number of bedrooms --3_- Number of baths __------ Lot size _-_ ❑ (]Other f ! A�7 Wafer Supply: Public s stem" E� 1� --`-.---•- !' Y ❑ Communit��Sr m'' --------------------- ❑ Private �pfh to Water Table ..--__- ft, Character of soil to a depth of 3 feet: Sandavel Sandy Loam E] Clay Loam ElCla Previous Application Made: Yes ElC � Y ❑ Adobe[] Hardpan E]onsfiruction: Yes El No No FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND S ECIFICATIONS: ❑ {No septic tank or cesspool permitted if,public sewer is available.within 200 feet. 1 Septic Tank: Distance from nearest wellfrom } -----------------Distance 'foundation- -----------------Material--_-- +____ Q, No. of compartments .....-------Size-'-----•-------------------------Liquid depth ---- Distance from nearest well d ' ---'^"Distance from foundafio _/x9 Vis..-ri.. l is®a ie d: Number of isfance fro� Distance to nearest lot line_ -r „� � r Length of each line---:---_--4 Width of trench-----;4 X_ Type of filter material--_ _[ i --t Depth` of filter material---/�}`- ----- Seepage Pit: -----Total length------/�� r . Distance to nearestwell------- _`Distance from foundation_=_.--------------- ❑ Number of pits_ --_-__- ---_--__Lining material-------------- -- -Distance`to nearest lot line--_---_--_---_-.- Cess ool: T Size: Diameter_'. Depth ❑p Distance from n Barest well'----------------Distance from foundation Lining material_--.----.._--_.---_----_ _ Size:,Diameter.----------- Depth•------- - - ' ------Liquid Capacity -------- Priv ------- - Y� Distance from nearest well---- _______________ f_ ---------gals. -------------------Distance from nearest buifdin ❑ � "Distance to nearest lot line :-^'_�- --_-_:-_------_- - 9----=---------------------- •4 s- - ------------------`-- •---------- __-_--_•----.- modeling�ndLor__cepa rin9-(descriE�e;--a.z------- - Re { ------------------------------------ ------ - .. --------------- -------------------------------------------------------- •---------------------------•-•--'-------+--- ereby c that I ve prep 8' Phis applicafron and that the work will be done in accordance wifh'San Joaquin County ordinances, S to I ws, a rules an egulafions of the San Joaquin Local Health District. 4 _ (Signed)------ ------ * - --------------------- --------- -------•------------------------- ------------------------- {Ow gy; --------------- := - : = #� - ner and/or Contract (Plot plan, showing-size of lot,"Iota"tion of- teal-in.relation-to wells, Buildings, etc. can 0 _. _. {Title-- I be-placed-on reverse-side); � t FOR-DEPARTMENT USE�ONLY APPLICATION ACCEPTED BY.---- -_ ----------------------------- REVIEWED �� /� r � DATE--____/ � REVIEWED BY------------------- j t -- • :- - BUILDING PERMIT ISSUED i DATE �= ----------------- ----• - -----------------•----- - --------- aerations and/or recoinmendafions -'' DATE--- --------------- -------------------------- -- --------------------------------------------- ------- ---------------------- - ---- FINAL INSPECTION BY:- - - - ------ - f SAN JOAQUIN LOCAL HEALTH DISTRICT I 130 South American Street 3DD West Oak Street - Stockton, California ^m. 132 Sycamore Street 814 North "C" street Lodi, California Man+sea, California Tracy, California ES-9-21x1 , Revisaa 1•57 F.P.CO. t