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,-;4_-mAPPL,1CATION FOR. SANITATION PERMIT Permit No. . --- j • � - (Complete in Duplicate] C� j I s o A - Date Issued _---��/- -_-- 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;'with County Ordinance No. 549. JOB ADDRESS AND LOCATI ---------------------------------------- Owner's Name----- -t ---------- - ----- ------------- --------- Phone. Address -ter- + ------------ ----------------------------------------••--------------- ---•-•-----•-- Contractor's Name 1 ------------------ -------------------------------- ------.--.Phone E XInstallation will serve:; Residences: Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other. ❑ Number of living units: __ Num ber of bedrooms f ,� - � g o�=-- Number of paths Lot size ______________ Water Supply: Public system Community s stem Private � y f y ❑ ❑ -,Depth to Water Table'. --,___ ft:" Character of soil.to a depth of 3 feet:- Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ ClayK Adobe Hardpan ❑ Previous Application Made: Yes [] NoAgj New Construction: Yes ❑ No [❑ PHA/VA: Yes ❑ No ❑ , ` TYPE OF INSTALLATION AND.SPECIFICATIONS: (No septic tank'or`cesspool permitted if public'sewer is available within.200 feet.) p No�of compartments--- -=LM_ ---Size_-- '� ` -� f.Liquid d de th-...._.' ------------- Capacity_, i Septic Tank: Distance from nearest well.;_______ ___ ___Distance om :foundation___ __�__.______Material__--. _ :__ t s q p. _P-44 �}- .. s Di Field: Distance from nearest welf_.,_r`� --_Distance from fa�anon____ :._ __.Distance to nearest lot line--. -_-_ p Number of lines._____- __---____Length-of'each lida� Width of tr'ench._---- 1 r f . ��. 7 Type of filter material__ _ .r_._Depth of filter material---- _______-_.Total length--__ ___r -_ _ _ 141�„ I Seepage Pit: Distance to nearest well_""""""'---------Disfanc7 .from oun ati n--'!I._.(-_____.Distance to nearest lot line r �,,� �`. Number of pits-------------------Lining material..d�''cAt , �__Wizf Diameter----_c•�f-Z---------Depth_-- -, -'�---- ------ ii - - iCesspool: Distance from neares+Ewell_________________Distance from foundation._._---_____..._---.Lining material_----_____.___-__-_-- " ❑ Size: Diameter-------------- �- = ------ Depth-`"'-- s_ - F r Liquid-CalaacitY gals. ,. f . Privy Distance from nearest well-_ t_°______ _________ __ Distaa'nce from nearest building__ i( ❑ °Disfance-to nearesf•lot line. - ----------- Remodel•n_- and/or repairing (describe:-• r 9 / k � i ,,` 6 t -« ,! V F ._ 2 ___________________ ______________ _ _-________ __ ___ ----_-__--_.-_---.--_--_-__- _______________ -___-______ I k ! P 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 regulo°rEs�bf the San Joaquin Local Health District. Si ned �y { g } +!- � �d -R...,__1_ 4f ._ = t` - ------------------'---------------------------- -- {Owner and/or Contractor) By:------------------------------- ------i.----•--- •-------------------------------------------------- --------------------------(Title)-------------------------------------------------------------- (Plot plan, showing size. of lot, location of sysfem'in.relation to wells, buildings, etc., can be placed on reverse side). l FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY y ' r - - ; - - - DATE.---------.- -�REVIEWED BY-------------------------------- A. r - --------- BUILDING PERMIT ISSUEDi � fDATE ----------------------------------------------------- _ Aferatio and/o recommendations:_.______.__ -------------- ------ �4 ---- ------------ -- - � ------ --- --, --- • -------------------------- --------------- ----------- FINAL INSPECTION BY:----tZ, .-:_-- -- - - Date------- �_(1- -- ---�- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street i 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M Reviser 1-57 VP,CO_