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V ��' \} ✓/ APPLICATION FOR SANITATIQN PERMIT Permit No. -•__ •,�.� (Complete in Duplicate) -°�------------ Date Issued ---"/717�`� Applica4-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. JOB ADDRESS AND OCATION.-1J__ _. / Owner's Name--- ' 1/ a �� Lc�/ .� . - - ------ ------------------ ---- --- -•----------------- ------ Phone---- Address- --- _-�--._ -�4--C. rContractor's Name � ---------- -- ------------- - , --------------------------------------------- - Installation will serve: Residence - - ' ---`------ -------•------• Phone_/��---�-!•f�J ---- ----------- Apartment House ElCommercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _-l___ Number of bedrooms _--ZNumber of baths ,- - -_ Lot size _d_[J r Wafer Supply: Public system ❑ Communit s stem f f Y Y ❑ Privafe E4--Depth to Water Table�'_5�ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam E] Clay Loam [:] Clay [I Adobe 9--Hardpan E]Previous Application Made: Yes ❑ No Ea Construction: Yes ❑ No [t� 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 .................. ❑��r.f i`�� Na. of compartments------- ---- �------ ---Size-------•------------------------Liquid depth---------------- ----------Capacity-•------------------ - Disposal F Id Distance from nearest well---. d----__Distance from foundation--- _6/ .Distance to nearest lot line___ --�_ Pilo umber of lines----------------- - -- Len -------------- Length of each I'rne-- d-:�"'..- '' - r �� g `' .Width of trench-----� y '� ype Of filter material------- ---2- �r -------------- --X---Depth of filter material---- -j------------Total length------75 1 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 = Depth E rt ---------------------- ------------ • --- Liquid Capacity Liq ------------------- gals. Privy: Distance from nearest well ----_-------------- - ----- Distance from f nearest buildin ❑ Distance to nearest lot line _--___--- g--__---- - ---------------------------- \i •---------------------- --•--• �J Remodeling and/or repairing (describe):_--_--Ce • ` G y,. V " ati --- t - -•------- -----------•----------------------------------------------------------- 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 regulations of the San Joaquin Local Health District. (Signed) Z'-71 `5' e e-� - / - -' --(Oand/or Contractor) ----- - -- ---- ------ -------(Title)-----9-4-17 - --- ----- - - - at 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-------;&. --------------------------------- ---- EVIEWED BY-------------------------------------------- ------ ------------- DATE -------- BUILDING PERMIT ISSUED--------------------•----------- -----------------------------------------------•------ DATE Alterations and/or recommendations:--_.- ' --------------------------- FINAL INSPECTION BY:___.- ---------------------------- Date-. SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street Stockton, California 814 North "C, Sfreef Lodi, California Manteca, California Tracy, California ES--9-2M 145446 wrw000 12-S4