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ID\ � APPLICATION FOR SANITATIOr�A- N PERMIT T _ Perm�it,No, (Complete in Duplicate[ Date Issued_---t-�- 2,_,o4 -&-/---------------- pica,ion in _ is hereby made to the San Joaquin Local Health District fora per' to + F This application is made in compliance with County Ordinance No. 549. p construct and install the work hereindescribed. F JOB ADDRESS AND LOCATIO ------------ ---" " -- Owner's Name------ ------------ 7- : A cess----- - ------ Phone-------------------- --------------- k --------------- -------------------------------- t< ----•----------------- --------•-------------------------------- Contractor's Name-----�----•----•---_ 1/� - � � --------------- ------------------------ ------ Phone-------- Installation will serve: 'Residence L`�{'rApartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other E] l Water Supply: lNumber Publicgystem Community bedrooms _zPri Number of baths --I--- Lot size -------Cts"- X I, -------------------- f Y E3 ate ❑ Depthto Water Table .Y- ft. Character of.soil to a depth of 3•feet: Sand ❑ Gravel ❑ Sandy Loam ❑.. Clay Loam ❑ Cla Previous Application Made: Yes Y ❑ Adobe Hardpan ❑ ❑' No� New Construction: Yes No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: r (No septic tank or cesspool permitted if public sewer is available within 200 feet.]~ "' - t _ s Septic Tank: Distance from nearest well__/4 _ istance fr fou - �_. Q Material ` No. of compartments-----' "Size_;___ ! " - LiquidCapacity - W Disposal Field: - . Distance from nearest well-----N_ L?_._Distance from foundation------�_-v-"_.-,Distance to nearest lot line--..- --------- Number of lines________ ' . �ZI---------=Length of each line V---------------Width of tronch ---------------------------- Type ~ of filter material_____ -_t- L--__-------Depth of filter material----.I$'�_t-_ / Total leng+h --jlfJ------------------------ Seepage Pit: Dista"n*ce�to nearest well------ _ "Distance from foundation_ _____ Number �-----------------Distance to nearest lot line_____:"_""_"-""_ ❑ Number of pits---------:-------.----Lining material------------------- -Size: Diameter--------------- ......Depth-----------------,-------- -------- p , _______________Distance from foundation.____---.i_--------.Lining material_______._ _ �1 ----------------------- Cess❑ool: SDize a Diameter nearest well ;---- --"--"--Depth---------------• "--� Li r quid Capacity -------------------------gals. V PrrvY:, Distance from nearest well________________________ -_-.--_Distance from nearest - -- building—Distance to'nearest'1otline--------�----------- ----------- ---------- ---•--------------. ._. - " + f Remodeling and/or repairing (describe)__________________________.__ ---------------------•-••-----••--------• ----------' _ ---------- ------------------------- --- = ------•-----------•-------------------•------------=---------------------------------------------------------------------------------------------------- ------ 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, and rules and regulations of the Sart J'aq� Local Health District. : (Signed)-.----------------- - -- -------------- -(Owner and%or Contra r { $Y:---------------------=-------------•--------------- Title _ (Piot 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----------------------`-- ,t - REVIEWED BYJr �9 DATE -----------•--------•------- W ----------------------------- ------ -------------------------- DATE---•--------------••----•---• - -- - - BUILDING PERMIT ISSU ---------------- •------------ --------------------------------- - DATE Alterations and/or recommendations:__"-----_""-.;,.---_---- _ ---------------------- - -- - - ------ ------------•"-- . J -------- ---------------------- ----- r ••-------------- _______________________________________ _ ____________________ _____________ __ ___ ___ .___.___...._-.__________..___-__-. --------- - __•-_ -----•--`----�r--------------- ---"-____• __- _ _-------- GCJ`� __________________ _____________________________________________ 1.0241- FINAL INSPECTION BY:_______ .?YrItz 1.011 DateJr 00 ------------` --------- -------------- 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-9-2M Revised W-2100