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APPLICATION PQR SANITATION PERMIT Permit No. _ - . -- - _ (Complete in Duplicate) Date IssuedApplication is hereby',made to the,SanlJoaquin Local Health District for a permit to struct and i he wor herein described. This application is-made-in compliance with County Ordinance No. 549. JOB ADDRESS AND AT10 -- Owner's Name-_-•_-- - - - Address-------------•-- ` -,., -------- ------ --------- Phone- = � - ---•----------- ontractor's Name__.__ x^ • ------ Installation will serve: Residence ---- -- --- ------------------------P — - hone ------- i [ir•Apartment House Commercial ❑ Trailer Court Number of living units:'-/__"- Number,of bedrooms `.x ❑ Motel ❑ Other ❑ _Number of baths __ Lot size _"�f_ } Water Supply: Public s stem' 7 ;Kf Y ❑ Commun'ify-.system ivate ❑� 'Depth to'WaterTable 4/4- Character of soil to.a`dep+hof 3 feet:: Sand ❑ Gravel Previous Application Made: Yes No. ❑ Sandy Loam ❑ Clay Loam [] Clay pp S y ❑ Adobe ardpan ❑ ❑ � New Construction. Yes o ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: t (No sap}ic +ank or`cesspool permitted if public sewer is avai€able within 200 feet.) 4 Septic Tank: Diistance-from nearest well F rs " - foundation Li -- --------.Material_.._ No. of c'ompartments____ _ " _____________ __Size_a��rom foundation___ ""- ! ' ----_--•-- /r ••---` Disp�osalfF Field: Distance from nearest wiell pistance from foundati 4 depAF th___ l7-_-_-_--__ � Capacity_--�ti~6 I ' on _ - Nurnber of lines______, -------.Distance to nearest lot line___-- ' ---------------------= - ength of each line--- -�`"� � ---------- Type Width of trench --- r� Type of filter material_ 'l �. -.-- epth of filter material__/ ��_ Total length------ �` Seepage Pit Disfa'nce to`nearest well_ ' it Distance from fou anon__..__ ;c o %J� t f v ______.Distance to nearest 1ot31ine__-"" "--------- m,�� Number of pits.-_._/_.-"_".-_"___Lining erial/ a` rize: Diameter "` " _ Cesspool: ----------.Depth__ -- (� 11 ----------------- ❑ Size,a Diameter nce from nearest welL_----.---__----_Distance from foundation -_-_,Lining material"_____"---- I � Depth =" -------------`-------Liquid Capacity gals. 4 iirivy: + Distance from nearest well_.._-. _:---- -----------------------,_ -_-Distance from nearest buildin ❑ "' Disfance`t6'nearZsi lot line- g------------------------------------------ A } a € ----------------- ---- ----------- Remodeling and/or.repairing describe}:_______. i , i I 'v - •--------------- ------- - ,... ---- F Ts-tom•-��i _______________----------------------------- ------------------- ________ I hereby certify that I have prepared this applica+ion and }hat the work will be done in accordance with San Joaquin Count _ `. - ordinences, State laws,,and rules andtre ulations of the San Joaquin Local Health District. 9-�,� _.y (Signed)-:_ Pith B s ---------------------------. Contractor) ----------------------- --- • --- (Plot plan, showing size of, location of system in relation to wells, buildings, etc., can(be placed n revers -- - Od FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY___________ ____"_"_ -------------------------- REVIEWED BY--------------------------- -F �---' t --•----------------------- DATE------ - � ----------- ----- -----_ BUILDING PERMIT ISSUED_____•-_- 1 DATE_..___. --- -------- A€aerations and/or recommendations: - - - DATE ------------------ ----------- ----- --- '-4-- ------ ---- 4: ^^':'- �I� ,!�� - `"""-- 4`...�"-- ------------------ -------------- _ f--- 1=1NAL � � •-------- INSPECTION _-------- --- _ -,. _. .. _ •" . Date-_-- -- --------------- ------------ . � ). SAN JOAQUIN LOCAL HEALTH DISTRICT c 130 South American Street ~ 300 West Oak Street 132 Sycamore S+rest — Stockton, California ( Lodi, California 814 North 'C" Street Manteca, California Tracy, California *� E5-4-2M , Revises 3.57 F.P.CO.