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APPLICATION*-FOR"'SANITATION PIE 11"I"IT. Permit No. .L.Q__ (Complete in.Duplicate) Date Issued _,1115 :Application is hereby made to the San Joaquin Local Health District for a permit-to construct and install the wort; herein-described. (This application is made in compliance with County Ordinance No. 549. �'�Iy �Gz yG � x/7011' !JOB ADDRESS AND LOCATION-_____ �' I ¢ t -- 3 , S Owner's Name---------------------'`-x -•-' ------------------ --• l.Mf.L9tl df Phone- y. ________________ ___ Address ---•-------• --2-? -)------ Ua------i-------------------- Contractor's Name -5l' 1�- �+i ------I- ------------------------------------------ --------------------- Phone Installation will serve: Residence [v�Apartment House ❑ Commercial ❑ Trailer Court 14. ❑ Motel ❑ Other ❑,M1,7( e Number""'of living units: __7.. Number of bedrooms -------- Number Number of baths,,_)CLot size ¢-c,c4�._1gS/ ',Water Supply: Public system Community system [] Private ❑ Depth to Water Table -------- ft. Character_,of.soil to a depth of 3 feet: Sand ❑ Gravel Sandy' Loam Clay Loam Cla ❑ ❑ Y ❑ y ❑ Adobe �-lardpan ❑ Previous Application Made: Yes ❑ No New Construction: Yes ©�No ❑ FHA/VA: Yes ❑ No [4,- TYPE OF INSTALLATION AND SPECIFICATIONS: _ .�.:. No se tic`tank or'cess ool fi ) P � p permitted if public sewer is available within 200 feet.) f � Septic Tank: Distance:from nearest well._7Distance from foundaion--- - Material____No. of compartments-. -�----------------Size...&X_ -------------------------------------------- i _ ___________------------------------------i y Liquid depth---- ------------------Capacjfy_.___q__0Z Held: 'Distance from nearest well___Distance..f ram foundatio_n_._-10_______ _--Distance to nearest lot line__S-_________ ❑� -- Number of lines---------3------------ ----._Length--of each line:----Y -3-------------------Width of trench.-----2 ---------------- ---------- --- Type of filter materiaL.__Yc�_------_De th of-filter materia!-__-- !� x P � ' ----------Total length-----------' ------------- Seepage Pit: Distance to nearest.weft '--------------- ---Distance'from foundation--------------------Distance to nearest lot line-----Dumber of pits----------------------Lining material_ - ----.Size: N1 Diameter-----------------. ----.Depth-------- Cl ----------- S esspoo : Distance from nearest wel!_________________Distance from foundation______.__-_._____.Lining material-------------------------------------❑ Size: Diameter------------------------- ------------Depth--;-------------------------------------------------Liquid Capacity----------------------------gals. � Priv ._ Y Distance from nearest well __________ -------------Distance from nearest buildin ► L �; g - ❑ Distance to nearest lotline------------------------------- -- Remodeling and/or repairing (describe):-1-=_-:----- ------------------ - ----------------------------- ____---------------- -----------__r_-____.f---------_--------------------------------------------------- -_.--____.-_____-__-__ ___________________________________________________________ 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 re ulations of the San Joei , cai Health District. [Signed----- �Y--� � - �_ - ---- '- - [Owner and/or Contractor] P •------------ --------------------------•--------------------------------------- - -- ----------(Title)1 lot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY , APPLICATION ACCEPTED BY__._-- _ CJ-- -------- ---- --�-�-� DATE- I L� Jj REVIEWED BY --- ----- ---------- - ------------------ ----- -- .. ---------- -� ------------------------------------� DATE------------------------ BUILDING PERMIT ISSUED--•---------------------------- -----_---------------------------------------------- - ------------ - DATE- Alterati --------------------- ons and/or recommendations--------------------- ....................... ------------ -•------------•---------------- -------------------- ------------------ FINAL INSPECTION BY..------------- . ----- I ----- ------------------------------ I 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 . Revisetl 1.57 F.P.CO.