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.n APPLICATION FOR SANITATIOI'�;.,'PERMIT Permit No. ._49_Z_7..._.... l� (Complete in Duplicate) V 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 L CATION&"' --�_��' �`-[- --_--- ��.. •----- '2 - ' Owner's Name-----� ._ L.�/-� ------------------------ ----------- Phone------------------------------------ Address--------Q.a --------- -- �? / ----•- '..- Contractor's Name---------------- ----------------------------------- ---------------------------------------- ------ Phone..--------------------------------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __..�___ Number of bedrooms _3_- Number of baths __�Lo+ size .__A�i_ ___ _________:__ _____ _____________.___ Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ AdobeX Hardpan ❑ Previous Application Made: Yes ❑ No A New Construction: Yes A] No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: , (No septic tank or cesspool permitted if public sewer is available within 200 feet.) _ Septic Tank: Distance from nearest well____ __�_.___Distance from foundation___ ---------Materjai___ _____________'__________: ----------- X e.� / Liquid depth---------+� --------Capacity--- - �' No. of compartments_____ _ _____________Siz _ _ Disposal Field: Distance from nearest well..g7._�_-------Distance from foundation__-_._ Distance to nearest lot line-:;� __f" Number of lines________ __. Length of each line_ . -- idth of trench_.___' .___. Type of filter material_�_�___ Z,.Depfh of filter material___.___`%_Ydl length--------- _ __ _________-__ Seepage 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------------- ------------------------Depfh---------------------------------- -----------------Liquid Capacity-----------_- --------gals.'- Privy: Distance from nearest well------------------------------------------------_Distance from nearest building------------------------------- ❑ Distance to nearest lot line---------_--------------- ----------------------------------------------------------------------------------------------- ------- . Remodelingand/or repairing (describe):--------- ---------------------------- ------------------------------------------•-- ------------------------------------------ ------------------- ------------------_----------------------------------------I-------------------------------------------------------------------------------------------------- ---------------------•--•--------•----------------------------=--------------••-•------------------------------------•-••-----------•--•----------------------------------------- -------------------------------------------------------------- ------------------------------ ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- I hereby c fy that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, St ws, d rules regulations of the San Joaquin Local Health District. ----------------------------- - -------------------------------------- ---------------------------------------- Owner and/or Contractor i (Signed)------------------------------ ----------- - ( / By: - Tale - ----------- - ------------------ ----- -- - ---------------------( � )--------------------------------------------------------------- (Plot plan, showing size of to#, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY e APPLICATIONACCEPTED BY--------------------------- --- �---------------------------------------------------------------- DATE--------------------------; REVIEWED BY----- -------------------------- DATE BUILDING PERMIT ISSUED-----------------------•_-- DATE f Alterations and/or recommend ations:----------.____:.____ ----------------------------------------------------•-------------------------------- --------------------------------------------------------------------- ----------------------------------------------------------------- --------------------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------- - l ------------------------- ------------------------------- ---------------------------------- FINAL INSPECTION BY:. Date /2_`� 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 p ES-9-2M 10-52 Revised W-2100