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APPLICATION K, SANITATION PERMIT.' Permit No. ........................ (Complete in Duplicate) G r Date Issued Application is hereby made to the San Joaquin Local Health District for a permit t90Consfrucf and install the work herein des This application is made in compliance with County Ordinance No. 549, r .° j,v 5.t LO` � JOB ADDRESSL_AN LOCATION_. C - V" V -- ---- --- - t Q Owner's Name____ -- -- �4 f- - rno'e� (� Address---------------- -------------f -� Contractor's = Phone Installation will serve: Residence 19, Apartment House E] Commercial [j Trailer Court [:] Motel E] Other E]Number of living units: ___/___ Number of be�rooms __�y Numb f baths_ _____ Lot size __ __ �-- -. _____-________________ Water Supply: Public system ❑ Community system ❑ Private�Dept totWater Table ________ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Clay Loam ❑ Clay [] Adobe ❑ Hardpan ❑ t Previous Application Made: Yes ❑ No � Ne Construction: Yesk No ❑ FHA/VA: Yes ❑ TYPE OF INSTALLATION AND SPECIFICATIONS- (No septic tank or'cesspool permitted if public sewer i 4vailable within 2P..feet.) Septic Tank: Distance from nearest well__� >b----Distance from foundation___1._fl-----------Material-_C01,c ___----_---- No. of tom artments_____ p �- ----Sire - - � Liquid depth Capacity Disposal Field: Distance from nearest well_--� 0--Dte from.foundation__�__6___________Distance to nearest lot line---- f Number of lines--------- --------- --------- ;gth f each line------- oftrench-._-_�„�I/-------------N. -•--- 4p Type of filter material_ iter material____ _R �__-__._Total length___ 1 Yp - } - {� Seepage Pit: Distance to nearest well_____________________Dista e'from foundation--------------------Distance to nearest lot line-____-___________ ❑ Number of pits----------------------Lining material ---------------.Size�'Diameter------------------------Depth--------------------------------- _.____'___Distance from foundation._.__._.`_.F___-_ Lining material------------------- Cesspool: Distance from nearest well------ ❑ Size: Diameter----- ------------------------------Depth---------------------------------- ----------,'-- Liquid Capacity----------------------------gals._ Privy: Distance from nearest well---_---------------------------------------------Distance from(nearest building -------------------. f ❑ to nearest lot line -------------------------- r -•------------x------------------------------------------------------ Distance �Remodeiing and/or repairing (describe): a -J ------------------------------•-'------•----------------------1'red:thi!-application-and ------------ ..� '-------------------- ------------------------ ------------------------------ ------------------------------ --------------------------------------------------- ------- iC i yT i r.-------------------- --- --------•---"'-'-------•----------------------------------------------------------'--•-'.------------------------------------------------------------------ I hereby certify that I have pre tha+'the work will'be"Clone in accordance with Sanl.oaquin County ordinances_State laws, and rules and regulations of the San Joaquin Local Health District. (Signed) `�(7.-► = __w+------------Y-6------ --'- -----------------------------------------------(Owner and/or Contractor) By------------------------------------------------------ -• ----------------------•--------(Title)--------------------------------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------------------------- ----- ------------------------------------------------------------- DATE----- REVIEWEDBY------------------------------------------------- ------- ----------------------------------------------------------------- DATE-4-------_ -------------------------------- BUILDING PERMIT ISSUED---------------------------- ---------------------------------------------------------------- DATE----- --- ------ Alterations and/or recommendations:__._------- -._ e" -------------------------•------------------------•--------------------------- --- -.R1---------------------------------------------------------------------•--•-------------- ----11-'A---------------------- ---------------------------•--------------------------•----------------------------------------------------------------- -------------------------------------•-----------------------------------------------------•-------- FINAL INSPECTION BY � ---------------- Date---Pt "_ ."• + ------------------- ..,.. SAN JOAQUIN,LOCAL,HEALTH DISTRICT r ► t- X30 South American Sc-# a �+a i # � V � � �""-500 West Oak Sfreet 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M , Revises 1.57 F-P.CO.