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�/" r .✓ APPLICATION FOR SA 7 SANITATION PERM7_4 Permit N _ 7 7 $1 (Complete in Duplicate) I date Issued . Q Application is hereby-made to the San Joaquin Local Health bi This application is made in compliance with County Ordinance N*. 549. a permit to constrcnstall she work herein described.Ad + 1( JOB ADDRESSLOCATIOO r - wner s Name--$,cw------ ;�---- -------- ------•--------------------------------------------------------------------- ('hone .' Address--------•- -•-• -- -- ------- ------ ; " ►r { ------------------------- ------------------------ Contractor's Name---- _._ -------- _ -------------------------------------------- CAP - ---------------------------------------------------------------- Installation will serve: Residence Apartment House 0 Commercial ❑ Trailer Court ❑ otel one—---------------------_ Number of living units- __ __ t❑ O her ❑ Number of bedrooms -_ _ Number of baths - __ Lot size _-_--- - X=- _------- Water Supply: Publicsystem PPY ' Community system ❑ Private ❑ Depth to Water Table --------- t. Character of soil to a depth of 3 feet: Sand Gravel E] Sandy Loam Clay Loam ❑ Clay be Hardpan ❑ Previous Application Made: Yes El NO New Construction: Yes No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if p__eeu..,,blic sewer is available within 200 feet.) � Septic nk: Distance from nearest wail_SY-Q----Distanr� from undafj,gn_---`";1,!_----_-_-.Mat rial__ -9 No, of compartments------------- - y y6, �ryC,r E Size- - ---------- - - -------Liquid dept ------— - Ga Ri -------- pY -- S- Disposal Field: Distance from nearest well 4DQ_"-_Distance from foundation_---`�__�_ _--Distance to nearest la+ lin Number of lines------------ - 7 7, f -----------• Length of each line_---1__. _- Width of french---- Of E, filter material 'T ---- ------ ---•-• ' epth of filter material----_-_� _ ' - Total length----------------- -- ~-- Seepage Pit: Distance to nearest well__________________--_Distance from foundation___--_-__-__-_--.Distance to nearest lot lI Number of pits----------------------Lining material____-----_--_-__ ___`-Size: Diameter----___- - - --- ----------Depth-----------Cesspool: Distance from nearest well-----------------Distance from foundation_-----"__,•--___---Lining material__---_.----____Size: Diamefier __-------Depth----------------=------- ---- -- . Liquid Capacity------------ Privy: Distance from nearest well---------- Distance from nearest building--, ------------ --------- 9 --------- --------------- ' Disfiance to nearest lot line-_ __---------------- ------------------------------------------------- Remodeling and/or repairing (describe)-------------------------------- -----------•------•----------------------- ------•---•----------•------------ ------ -------------------------•---------------------------------------------------------------- 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 regulaf,ions,of the,San Joaquin local Health District. (Signed)-------- ---`;----- ------ ------------ -------- ------------ ----------- ----=--------------------------Owner and/or Contractor) By:---------------------------------------------------'------ ----- Tifle _______ ___ (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------ BUILDING PERMIT ISSUED --_---"__ ---=----------------------------DATE----- Alterations and/or recommendations:-------.--___.---_ ------------------------- ------------------------- -------- -------------------------------------- --- ----------- ------------- - - --------------------- -------------------- FINAL INSPECTION By I � I - _7� Jr. -------- ------------------------ - --- Date-- ------------ --- ---- - - SAN JOAQUIN LOCAL HEALTH DISTRICT . 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy. California i ES-9-21v1 8-S1 Revised W-2)00