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.. •JJ�_ ll` a . �)L \ APPLICATION FOR.SANITAT}ONPERMIT Permit No. - - � (Complete in Duplicate} r Date Issued ,.? f' --. 3 # 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 Count inane No. 549. { JOB ADDRESS D L (;ATION..1Z -- ----- ----- - --- - Owner's N e -------•-------- ---------------------------------------------------••-------------- ------ -- ----------- Phone-------!!=r7777777 Address__.- _ - ----- --------- ---------- ------ --------- ----- Contractor's Na ____ --- --------•--------------------------------------------------------me ___________ -- � -------•------- t •---•----•---- ---- Installation will serve: Residence partmenf House ❑ Commercial ❑ Trailer Court ❑ Mo_tell ❑ Others ? - Number of livingunits::=__ �___ umber of bedrooms'l Number of baths �.- Lo' size _ •- Water Supply: Public system Community(system'❑ Private ❑ �Deptli f Water Table ________ ft. Character of soil to a depth of 3 feet:' Sand . Gravel ❑ Sandy Loam Clay Loam [] Clay ❑ Adobe�ardpan [] Previous Application Made: Yes No f ❑ i New Construction: Yes No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool perm=itted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well_ ___-_- Distance,from foundation__________--___.. Material-_______________ _ _ ___ No. of compartments------- --- --------------Size---------•--------- --------Liquid dep#h-- Capacity----------------------- Ca acit Disposal Field: Distance from nearest weil_�_____-_.__-__Distance from foundation_____________ . I --_.Distance to nearest lot line_____________ _� ❑ Number of Imes-------------------i--------------Length of each line--------!-------------1------Width of french----------------------------------- -----------------------of filter material------------------------Depth of filter materia ------------- -----Total length--------------------------------------- Seepage Pit: Distance fo nearestweil..__`� ""'""'-pistaneepfrom foundatio __ to nearest lot line---------------- ne F1 Number of pits.__.---.--------------Lining material------ ----------------Size: Diameter------------- --------Depth------------------------- Cesspool: Distance from nearest weft_________.__--Distance from foundation______________ _ Lining material ------------------ ❑ S,ze: Diameter--------I Depth_-__-- -----Liquid Capacity- ------------gals ---------- -------------- - Pr:vy: Distance from nearest well_-___... Distance from nearest buildin Distance to nearest lot line g-----./-�.------- ------------------ ` Remo e ing and/or r p rin (describe').- ----- - _ _ �. ---- --------------------- --------------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, and rules and regulationls of the San Joaquin Local Health Dis+rict. r (Signed)- --79 -------- - -------- ------- --- ----f- If 1 nor and/or Contractor Plo+ Ian, showing size of lot, ocation of system ' �v*�1------------- ------------------II- s.. --------(T0tle)________________ _____ _ By:._ - � f ------------------- p g [ in,relation to wells, buildings, efc., can be placed on reverse side}. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_ ._ f-__---. ----=--------------------------------------------------- --- DATI= IEWI_D BY ------------------------- ---- --------- -- - DATE- UILDING PERMIT ISSUED-------------- _ .....�_ �� ----------------------------------•--------- ------ DATE.---- Al+orations and/or recommendations:_--(__.___._-_- � ------------ -------~------ ---•----------- ----------------------- --- -•----•----------•- ----------------------------•--------•---- --------------------•---- ----------•---------------------I——---------------•- --•----•------------••---------------------------------------------- --------•--------------•-----••---•---- -----------------------------•----------------- •------------------- •-------------------- ----- -------------------------- --------------------- -- -- -------------- IU, - -- --- --------------------- ------------------------ -- ---------- ----------- -----------------------I------------------ --- -------- FINAL ---------------- -- --- - FINAL INSPECTION BY:---------"-- ---------------- I1 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 't ES-9-2M 10-52 Revised W-2100