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'YV APPLICATION FORS Permit No. -- -�-_-- - ANITATION PERMIT a 7 ..-- (Complete in Duplicate) � � 3 L 2-1 � J' Date Issued Applic&ion 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. .J JOB ADDRESS AND OCATIO r `5 .-..-._.. �� I ------------------------------------------------------------------ Owner's Name �_ ='" ------------- - - ------------- - ------ - ...... Phone------------------------------------ Address-------------------- - ` l � � / rt mss.. ..------------- ---------------------------------- -•----- ----------------------------- Contractor's Name---- `: l .--.-.... -r- ------------- -------------------------------------- Installation will serve: Residence p Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: - ____ Number of bedrooms -_3-- Number of baths _/..i_ Lot size _-___/_�*,-s lL_.---_/4-4�_. .... Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table %- it. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Q Hardpan ❑ Previous Application Made: Yes ❑ No Z_ New Construction: Yes & No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 240 feet.) , Septic Tank: Distance from nearest well-:�'P�i'_ Distance from foundation___%a_-----------Material-----. �.` _._ �-�✓I -.--_ __ No. of compartments-------, ---- Size_.5r_- -- (w----Liquid depth------4.4)-------.....Capacity----`.r ----.---- Disposal Field: Distance from nearest we'll_ _/s' . --._Distance from foundation----1 -..__ -Distance to nearest lot Number of lines....... ........ .... Length of each line_._. v-:-_Ts'_::7 _-Width of trench__- _-- ---- --_- -_-_-_ Type of filter material---yp ------ .-Depth of filter material-.__f__ - .-_.__Total length------- ----- Seplo ge Pit: Distance to nearest well ..___________-------_Distance from foundation------------------- Distance to nearest lot line.______.--__._. Number of pits---------------- Lining material-------- .....----------Size- Diameter------------------.----Depth------------------------.---_---- Cesspool: Distance from nearest well-------- _Distance from foundation__ _____________Lining material -----____---._-- ❑ Size: Diameter_ ------- -- - - - --.-..Depth - --- ---------- ------ ...--- --Liquid Capacity- --------------------------gals. Privy: Distance from nearest well___ _________________ -------Distance from nearest building---.__.___---.-_--------______-._.--.-. ❑ Distance to nearest lot line - ----- -------------- ------ - Remodeling and/or repairing (describe):----- - -- --- ------------ ----- -----------•----------•------------------------------------------------------------------------------------------------------ ----------------------------- - ----------------------------------------------------- -------- ----------------------------- ----------------------------------------------------------------•---------------------------------------•---------- -- ---- ------------------------------------- --. J ----I----------- --------------------- --------------------------------------------------------------------------------------------------------------------------r------------------ ---................ -- I hereby certif that I have prepared this application and that +he work will be done in accordance with San Joaquin County ordinances, Stat 'a , and rules and regulations of the San Joaquin Local Health District, (Signed) " Si -- Z_ ___ c gY -.-. � ----------. --- ----•----- --(Owner and/or Contractor) Plot plan, shown size of lot, location of system in relation {Title)_--. s � P 9 y +ion +o wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY..._y.----- --- - -- - ---- ----------------- - -- --------------------------------------- DATE_------------------- ------- -- REVIEWED BY------------------------- --------------- - - - - DATE-.' -- --------- BUILDING PERMIT ISSUED Alterations and/or recommendations------ -- --- - - - --------- --- ----------------------------------------- FINAL INSPECTION BY:------ f Date--- SAN ate-SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamdre Street 914 north "C" Street Stockton, California Lodi, California Manteca, California Tracy, California Es--9-2M 1gSgg6 AT Ctl ly-54