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APPLICATION FOR SANITA T QL IT Permit No. - mplefe in Duplicate) EXPIRES ONE YEAR Dat Issued Application is hereby made to the San J aquin�c I Health District fora e PROD RATE p ork herein described. This application is made in compliance with County rdinance No. 549. [ 3 - 2 p, Pj� IS K _j= JOB ADDRESS AND LOCATIONS - - = V --------------- ------------ Owner's -- Name___-0 � Phone------ - { ' 17 Address--- �-�- --- --- ---------- Contractor's Name----A-�_� ____---__ 77-0 ---------------- ------ -------------------- Phone ------------------------------------------------- - - ---------- Installation"will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court E] Motel ❑ Other, Number of living units: -------- Number of bedrooms -------- Number of baths -"7�--_ Lot size --------- d 2�'�le. ___ Water Supply: Public system El Community system ElPrivate,k Depth to Wafter Table _�8 ft- f Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam*1 Clay Loam E] Clay EI Adobe ❑ Hardpan E]Previous Application Made: Yes ElNoV New Construction: Yes [V No ElFNA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspoolpermitted if pu6lic sewer is available within 200 feet.) Septic Tank: Distance from nearest well___�_o d---Distance froq-1,foundation-- ------__ -----_Ma rial_"�L�v7t" ----- ------------------ No, of compartments------M-------------__Size"'�_�. '`d_ '_� Liquid depth_- -- -----------Capacity-A-- &D Disposal Field: Distance from nearest well.-f-------Distance from foundation_10_'_-"_____.Distance to nearest Jot line__. . ._. Number of lines----- Z.------------- , gr gth of each line-------f_Q ----------_Width of trench----X-apt _�' ----- ----_--- Type of filter material_f_~`I_ ___ -- _L pth of filter material_____ ��--------Total length------s2 0-t?_-------_-- Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line_______.__-_--.._ ❑ Number of pits---'------------------Lining material---------------------.-Size: Diameter_--------------------- - Cesspool: Distance from nearest well-----------------Distance from foundation-------------------- material__.____._-___.._______ ------------- ❑ Size: Diameter ---------------------------------Depth----------------------------------------------------Liquid Capacity- ------- -------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building____________________________ Distance to nearest lot lire % Remodeling and/or repairing (describe):____-____/"- -I y --- S+ _ --Y^- --------------------_ --------------------- .------- -------------------- -----_ ------------------------ ---------------------------- ----- --------- --------I------- -------- ------ ----- - - ----- 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, anA rules and regulations of the San Joaquin Local Health District. : , (Signed]_ -- �� ----- -- - ----- ---- ------ - -- -- -------------------------------- --- ----------------------- whet and/or - --(O d/o Contractor) By:--------------------------------•---------------------------- --- ---- ' -- - --- -- - -- - - --- - - ------(Title)-------------------------------------------- (Plot plan, showing size of lot, location of system in relation to wells,- buildings, etc., ca; be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY___ ----------- DATE, -/�� "� ------------------- I ED BY----- -----------------• -------------- ----------------- - - --- ----- ------- - DATE---- "- -------- --------------•- I DING PERMIT ISSUED--------------------------------------------- -------------- DATE----- Alterations and/or recommendations_____________________________ -- ------•------------------------------ -------- ----------------------------------------------------------- ------------------•----------------- --------------------------- FINAL INSPECTION BYDate.... C - -_d :r 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 ES-9-21x1 Revised 1-57 F.P.CO.