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APPLICATION -POR SANITATION PERMIT Permit No. .-..1-.. 0.. _-_ (Complete in Duplicate) J �J s-� Date Issued --/_• ----------- 4 _.__-__ 244 - � Application .,- is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein describ d. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION---` " � �• • ---------------- Owner's Name j } l A— ---------------------------- r Phone._, Address - ----------------------- --- � .._.-...- Contractor's Name --------------------------------------------------------------- Phone----•-------•---•------------------ Installation will serve:<Residence ❑ Apartment House ❑ "'commercial [► Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -------- Number of bedrooms -------- Number of baths I---_ Lot size Z467KP4------------------------------ Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table -24 ft. Character of soil to a depth of 3 feet: Sand [-] Gravel E] Sandy loam Clay Loam .❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: Yes ❑ No ❑ New Construction:' Yes ❑ No ❑ PHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: f F (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well _ -: '-Ristan e ra o n on.__-1�-.-------Materi I--L�/1^'G---! -----. p Y- .-- ® No. of compartments---------- -------�-_--Size-- -- - ----_-------: --Liquid depth E�'L--------------Capacity----- U --�-- -- i 10 Disposal Field: Distance from nearest well--7K-+ Distance from foundation- -�-distance to nearest lot line -_ +. : it -- �J Number of lines-- -- - "t" Length of each line Q Width of trench_- --• ------- --- / Type of filter material-_--- x_-- __-___--depth of filter material-----_ Total length-------.--l27 --------------- 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 s Liquid Capacity ---- --------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building------------------------------------------ Distance _----.---.----_-----_-----_--- .------. Distance to nearest lot line---------------------------------- o ---------------- - - ❑ - ------------------------------- ----------------- ---- Re�edeG:>� :. - s��rrkZa ----- ----------------- -------------------------- ---------- � = - -- - - ----- ------------------- ------------------ ------------------------ ------- -- --------------------------------------------------------------=-------------------•-----------•---------.. ----------------------- -A----------.--------------------------•- --------------------------------- ---------•------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ I hereby certify,'hat I prepared +his-application and that the work will be done in accordance with San Joaquin County ordinances, St s d rules and regulations of the San Joaquin Local Health District. (Signed) = -111 --- - ------- ------------------------------------------- ----------------------•-(Owner and/or Contractor) BY=----------------------- -----...... -------------------•---------=-----------------------------------------------------(Title)----------------------------------------------------------------� (Plot plan, showing size of lot, 'locatiom'of system in relation�to:wells,--buildings„etc., can 6e-.placed on reverse side). FQR DEPARTMENT SE O Y APPLICATION ACCEPTED BY------- - DATE---- \ REVIEWED BY--------------------------------------- ----- - DATE--------- --•-----•----------=-------•----- BUILDING PERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE------------- ----------------------------------- ----------- Alterations --------------------------------•Alterations and/or recommendations--------- --------- --- ----•---•----------------------------------------------------------------- ------------------------------- ...----------- ----- -- - - ------` '-- --- -- ------- -------- - -- --- -------------------------------------•----.-•-.- •--------------------------------------------- ----- FINAL INSPECTION BY-------- ------------- --------------------------- - --=-- Date------ ------,-- - ---------- ------------------------ SAN JOAQUIN LOCAL HEALTH DISTRICT E 130 South AmericanStreet 300 West-Oak-Street - 132 Sycamore Street $14 North "C” Street Stockton, California Lodi, California Manteca, California Tracy, California , ES-9-2M1 Revised 1.57 F.P.C4.