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e...•,,fir. � � .� � . A�P ICATION- FOR SANITATION PERMIT Permit No. q_r_-_g1---__.------ (Complete in Duplicate) Date Issued _ l__3f S"1------ a Applica{ion is hereby made th SanJoaquinLocal Health District for a permit to construct and install the work herein described. This application is made in compliance welCou Ordina ce No. 549. ' y g �2 ---- JOB ADDRESS AND LO ATION____.____ "___ f d� Z� --------------------- Owners Name---------- I_ __ --- *` r - - ------------ -----------------------------------/` a �--- _ ... r. - 7 f Phone .__ Contractor's Name_____-_ - � �-C.l—I Installation will serve: Residence Apartment'House ❑ Commercial ❑ Trailer Court Motel ❑ Other ❑ ` I Number of baths __ - Lot size`__' .__ _�_ `S---U- ----- ----------- Number of living units: ___- Number of bedroom Water Supply: "Publiclsystem (�Community system ❑ Private ❑ Depth to Water Table _ ft.' # } Adobe Hard an Character of soil to a depth of 3 feet: Sand ❑- Gravel ❑ Sandy Loam ❑ Clay Loam ❑ lay ❑ [fir P ❑ r Previous Application Made:. Yes ❑ No 0-- New Construction: Yes ❑ No [ET, 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-------------------_Material___-______.___"____________-.._______.___ -. No. of compartments �J!---size------•---•---------------- ---Liquid ciepth--------------------------Capacity - I istance from foundation_�d--r.--.----Distance to nearest lo��t//line._ --___-.- D sposal !d: Distance from tnearest well_ T�f/ � w �. -� Width of french_._a-7__._-------- RNumber of lines_____ _�_.____ "_____ Length of each line_____ ___55 ______x__-- �, Type of filter material_- t__�i> - p -- Depth of filter material-----��_1_._�_-.--Total length----------'S------------- "-----'-------- Distance from oundation_...2 _..___._.Distance to nearest lot line___`S _�____- Seepag it: Distance to nearest well�•d______�--- Size: Diameter____. is ��---o nearest _�_�____ __________ 99 Number of pits___._ : '--Lining material__ + - -- - f Cesspool: Distance from nearest well--------------- from foundation.- E..._ ----Lining material--______________________.____--_____. Qe the - ----Liquid Capacity----------------------_---gals. ❑ Size: Diameter------------------ '---•----------- P ri ---------------------------------------- Privy:' Distance from nearest well------------------------------------------------Distance from# nearest building ---------------------- ❑ DMance`to nearest'lot-line__`-------------------- ------------- ------- """ ------------------------- -- Remodeling and/or repairing (describe):_------------------------------------------------ --- - -------- ---------- i ------------------------------1.-------------------•-------------------•---•- ------------------------------------ 4 hereby certify AhaA I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, to laws; an rules and re ulations o the San Joaquin Local Health District. -� ` ' (Owner and/or Contractor) (Signed)---- - r------•--------------------------------------- By:---------------------------- (Plot plan, showing size of lot, Iota;ion of system ination to wells, bungs, etc., can be placed on reverse side). FOR DEPARTMENT USE.ONLY ter. 4 APPLICATION.ACCEPTED By.---- -- y DATE----- ---- --- - --- --------------- -� � DATE i � � ----- REVIEWED BY------------- - --- ----- - -- ----------------------------- ti DATE ------------------------- BUILDING PERMIT ISSUED F --------------- ----------- - - - ------- ---------------- Alterations and/or,reco ► endations:"________ �' -��.A � r - - •-------------------`-------••--------••------ -------------------------------------------------------------------------•------_--- ---- y # •-----. .. Date == FINAL INSPECTION BY:___' ._ �_ F.°-- --- - - SAN JOAQUIN LOCAL HEALTH DISTRICT " 130 South American Street 300 Wes+ Oalc 5+rest 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manfeca, California Tracy, California ES-4-2M ; Revised W-2100 --