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VI , _ C9 A PLICATION FOR SANITAT ON PERMIT Permit No. _3 --`_-y/___ (Complete in Duplicate) ` PDate 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 Or inance No. 549. //4,.. JOB ADDRESS AND LOCATION ------------" � �.►2 �.r— ------------------------ �. /, Owner's Name--------- --------- -------------------- Phone__, Z.! ----- � ` ' ��Address------------- I. � �. - _ ---------.-.----------------------- ---- -- - ------------- __)-11 ---•------ - Phone-- Contractor's s Name---------------------- -------•- --- --- ----rr4--- ------- --- J Installation will serve: ' Residence W Apartment House ❑ Commercial ❑ Trailer Court E] Motel ❑ Other E]Number of living units: ---`%!Number of bedrooms - --_- Number of baths 4�1 Lot size d_ "` --------— �_ ?-_-----. Water Supply: Public system,s ' Community system ❑ Private ❑ Depth to Water Table ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑ Noj�:[ New Construction: Yes ❑ No ❑ .,�.- �,, ,;,c TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) tic Tank: Distance from nearest well-----------------Distance from foundation-------------------_Material--_------____-_____------_-_.________---_--_. -T� No. of compartments Size Liquid depth - Capacity posal Field: Distance from nearest well_________________Distance from foundation--------------------Distance to nearest lot line-___-__-----_--- �: --�� Number of lines-----------------------------------Length of each line-----------------------------.Width of trench----------------------------------- Type of filter material-------------------------Depth of filter material-----------------------Total length-----------------------__--_---_-_------- Seepage Pit: Distance to nearest well 6--_'----_--Distance from foundation---` __ -.Distance nearest lot line-�f�?__-_ Number of pits-------/------_-----Lining material-4 t _.Size. Diameter----s30----_.___Depth---- 3 ----------------- Cesspool: Distance from nearest well-----------------Distance from foundation-_-----------------.Lining material--------------------._-.-___.__._-_.. ❑ Size: Diameter---•----------------------------------Depth----------------------------------------------------Liquid Capacity---------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building------------------------------------------ ❑ Distance to nearest lot line----------------------------------------------- -•---------------------------------------------------------------------•------- h Remodeling and/or repairing (describe):- -f --- - 4- � ----� �y� t .... t_ -------------------------------------------•------------ ------------------------------------------ ------------------------------------------- ----- --- ------- ---------- 1 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 regulati ns of the-San Joaquin Local Health District. 1L1h!' = 4-= i-ry '` �} -__ Ownern Contractor 1 (Signed)-----�----'----- ---------------------�-_ � 1+• _ [- �. � �l BY: f tff-,: '- --a--.u-------- -------------------------------------------------------(Ti+le)---_ � ------------------------------ (Plot plan,�ng size of lot, location of system in relation to wells, buildings, a+c., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-----------------------4------ DATE-------------- —-------------------- REVIEWED BY----------------------•--- ------- DATE-/e)-7-J..... -- 17,( BUILDING PERMIT ISSUED-------------------- DATE------------------------------------------------------------- Alterations and/or recommendations:------------------------------------------------------------------------------------------------ ------------------------------------ ------------------- ------------------------------------------- -I-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------- --------- --------------------------------- ----------------------------------------------------------------------------- -------------------------------------------------------------------------- - ------------ ----------------------------------------------------------------------------------------------------------------------------- 1*V14 FINAL INSPECTION BYfA_ ----- Date---J6---1 _''`�' 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 8-51 Revised W-2100