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�3.. APPLICATION FOP, SANITATION PERMIT Permit No. tj 41 (Complete in Duplicate) Date IssuedY-61 Application is hereby made to the San Joaquin Local Health District This application is made in compliance with Countx Ordinance No. 549r a permit to construct and install the work herein described. JOB ADDRESS AND LOCATION __,--- / �4 S , Owner's Name-------- -- y'�� -------•------------------------- ----•-----•--••--------------------- Address - Phone O�f. .---------------- :.., --------------- Contractor's Name'!-.---•-----•---•--- ------------- ----------------------------- ------ Installation will serve: Residence Phone__________________•-_-_ ,- � Apartment House ❑ Commerci�1 -- ---• Number of It ing units: __�__�Number of bedrooms _ A ❑ Trailer Court ❑ Mot' ❑ Other �._ Number 1f baths __/--- Lot size ___ y� Water Supply: Public system ® Communit system "� " -------------------- �: Y Y Private ❑ Depth to Water Table {}- Character of soil to a depth of 3 feet: Sand''[] Gravel ❑ Sandy Lo ❑ Clay Loam ❑ Clay Previous Application Made: Yes No Y ❑ Adobe Hardpan ❑ ❑ ® Now Construction: Yes El No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: CA (No septic tank or cesspool permitted if public sewer is available within 200 feet.) I Septic Tank: +Distance-from.n ea rest well___-_40�___ Disfia fro fou tion.---70-�_--_ ® No. of compartments---_ ..-. -_--__----SMate�ial____ Lf1 B D --- Disposal Field: Distance from nearest'rwsl D X _L'quid depth-___ -� ___.------_---Capacity....e L `J'--..-______Distance from foundation_-_-�___----pistance to nearest loft line..... - -.--. Number or lines________ ___ Length of each line-,?&I OF ----- -- '-_ �/ of Type os filter material__- ', 0. Depth of filter material-__-.-1 dTotlalthlength french.j Q Seepage Pit: Distance to nearest -- -- Distance from foundation------------- ------ / ❑ Number of pits..__P_-.i_-_______3 Lining material__-__..___-_-_- Distance to nearest lot line_________________ ------Size: Diameter---------------------- Depth--- -------------- Cesspool: - Distance from neare�t well_-_-------. Distance from foundation --------------------Lining material-__--_- ❑ Size; Diameter-__._.__ ---� ------ ----- ----------Depth- ------- -------------- ----- ------ -- - Capacity. ----------- Privy: Distance from nearest well------------- - ---- -----Liquid ..- gals. , ❑ Distance to �stlot�line_-___.____-___ Distance from nearest building_____________________ __ --- -- ----------------- -•--•----------- ---- - - - -------------- RemocLeling and/or 1pairing -- ------•------- -------------------------------- -----------------i I . . ------•---•-••-----------------------------------------------•--•----------------------- ------------------------------------------ I hereby certify that have prepared and regulations as plication and that t ------------------------------------------------ ----- ---- -- -- ordinances. State laws he work will 6e done in accordance with San Joaquin County -� g of the San Joaquin Local Health District. (Signed)------ -; 1 ---------------------- By: -------------------------------- --------Ow - (Owner and/or Contractor) { plan, - ------------------------------------------------------------------ -------------------------------(Title)---------------------- ------------ Plot showingsize f lot, location of system in relation to wells buildings, etc., can be placed on reverse side]. w FO PARTMENT U E ONLY r APPLICATION ACCEPTED BY---- - -_-�_ .� REVIEWED BY -- ----• --------- DATE...-- r BUILDING PERMIT ISSUED i ------- DATE------------- ------- Alterations and/or recommendations:-------_'_---_-----_- - DATE -------- ----------- ---•--------------------•-----•--------------------- --------------------------------------- ------------------------------------------------------------------------------------------Z-------------------------------------------------------------------------------- -------I---------------------------------------------- --------------------4------------ ---------------------- -.-- ---•- ------------- ------------•------ ---------------- ------------------------------------ ------------- ------------------------------------• - ----------------- ------ ------- ---------------------- FINAL INSPECTION BY:.............. - ----- --- - ....................... ----- -- - ---------- Date-------------- . --� ;SAN JOAQUIN LOCAL HEALTH DISTRICT { 130 South American Street 300 Wes} Oak Street Stockton, California i32 Sycamore Street 814 North "C" Lodi, California Street Manteca, California Tracy, California ES-9-2M I0-52 Revised W-2100 � -