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APPLICATION FOR SANITATICII PERMIT Permit NoA�k__P_4-. (Complete in Duplicate) 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. JOBADDRESS ANLOCATION---- f �i ----- --- -- ---------------------------------------•-------------------------------------------- t W Owner's Name . " - Phone r�` 1 Address ? = -------- Phone Contractors Name______________ 'r Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court JK Motel ❑ Other 0 Number of living units: _{, ^_ Number of bedrooms _______ Number of baths _ __ Lot size -------- ----- - i---------------------- I Water Supply: Public system ❑ Community system ❑ Private JK Depth to Water Table ________ €t. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: Yes K No El New Construction: Yes,]4 No El P144• im1k QV- S i+e S fle a I' ('41rJ 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 10{2_-r-______Distance from foun9)-Liquid_tion_____ --------------------f-- --- No. of compartments__-___--- -_------Size_.��_ � depth--------Aa'_--------Ca Capacity-,;LOP----- Disposal =---_ Disposal ,- Field: Distance from nearest well___137-O-. _Distance from foundation to nearest lot line___`'________R ' Number of Sines----------I-----------------------Length of each line---__a4_QA---------------Width of french------a-- _------------------Nk Type of filter mate rial_I'h!W ___Depth of filter material-----1$-`-`-__--_:__-Total length__._____ '______ ______________ Seepage Pit: Distance to nearest Distance fro/m foundation____--- =......Distance to nearest lot line_________________ Number of pits--------/------------Lining material_17?tkA ize: Diameter-------�-3.........Depth--------:?-__7-'--------------- Cesspool: Distance from nearest well_________________Distance from foundation_---------___..____.Lining material------------------------- El Size: Diameter--------------------------------------De th---------------------------- ------- -------------Liquid Capacity ------gals. Privy: Distance from nearest well_----------------------------------------------Distance from nearest building-----------------_---_---_______________- ❑ Distance to nearest lot line---------------------------------------------------------------------------------------------------------------------------------------------- &I r- . Remodeling and/or repairing (describe);____��- _,___��:�d---�--�P---- -�r''�`-`-'�---�----:-- --��---- '---' --- ��f E ------- _RA-�.s.A -:_ n --� -- -----U Q' - •--------�---- eat� :.-��--�-+�---��°� � -------- e-------------- I hereb� certify that I have prepared this application and that the rJork will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. * (Signed) Owner - (Title) (Plot plan, showing size o 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------ BUILDINGPERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE------------------------------------------------------------- Alterations and/or recommendations:---------- --------------------------------------------------------------------------------------------------------------------------------------------------- k ------------- ---------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------•--------------------------- } ------------------•--- ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ' ----------------------------------------------------- --------------------- ----------- ------------------------------------------------------ ------------ ----------------------------------------- FINAL ----- ---------------------------------FINAL INSPECTION BY Date :. _ f-- . ------------ 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 1 ES-9-2M 8-51 Revised W-2100