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-APPLICATION FOR SANITATION Pt:;CMIT go�) Permit No. ._./-1...�:z,P • Q (Complete in Duplicate) Date Issued _...__ Application is hereby made to the San Joaquin Local Health District for a permit to c nb�struct and install the work herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION------ __ Owner's Name ---•- 'k!�'-"�. k- --•-•---------- ------- --�----------- -------- Phone------------------------------------ Address ----------- - ------------------- Contractor's ----------------- 4 r �� Contractor`s Name- ---- --------- ------ ----- ----------- Phone----•-------•---------------------- 4i Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other Number of living units: -------- Number of bedrooms -------- Number of baths--------- Lot size __-_-----------------_---_-___--_---__--__-------------_---- Water Supply: Public system ❑ Community system ❑ Private [g) Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe&-,I' Hardpan ❑ Previous Application Made: Yes 4� No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or`cesspool permi+fed if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well-----------------Distance from foundation---------------------Material--------------------------_-----_.--------_---_. ❑ No. of compartments-------------- ` Size--------------------------------Liquid depth--------------- ----------Capacity--------------------- Disposal Field: Distance from nearest well_,W-_..-Distance from foundationA-------------Distance to nearest lot line__-----_- 1 INumber of lines---------------/------------------Length of each line-----------------------------.Width of tre ----_-- - ,E Type of filter material-`�QC�---------De th of filter material ' , rs Yp o� p l ----------.Total lengfih ' S it: Distabnece of nearest well-_LD _-.-_-_ Distance from foundation__-, (�_____ e to n arest"Iot line.._` �_-_____ p ------------Lining material----'Pd-C_`�----Size: Diamet --- --- -----.Depth------1�6-~"----------------- Distance from nearest well-----------______Distance from foundation-------------------- in' materraC____-C3-------.--------_-----_-. � ❑ Size: Diameter------------------------- ------------Depth--------------------------------------------------._Liqui.d Capacity-----------------------------gals. 0 Privy: Distance from nearest well__________________________-__.__.-____----.----Distance from nearest building_______---._------__-_-__-_______-_-__---. ❑ Distance to nearest lot line.---------------------------------------------------------------------------------------------------------------------------- Rem eiing and/or repairing (describe}:___'__._.__ ------------r / Y' = 'TA-149;2 ------------------------------------------------------------2--- -------------I--------------------------------------- -----------------------------------------------------------•---------------------------------------- --------- ---------- - 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 regulations of fhe San Joaquin Local Health District. 1 .� QA-111111-1 - ---- (Signed)-=-------------------------------------------- 1111 1 ----------------------------------------------------------------------------------(Owner acid/or Contractor) By-------------------------------------------------------------------------------------------------------------------------------------(Title)---------------------------------------------------------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). I FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---------- / ----------------------- -------------------------------------- DATE REVIEWED BY------------------------------------- #--' - ---- -- DATE f BUILDING PERMIT. ISSUED--------------------------------------------- --- -•----- ------------- C. - -- - - ---------------------- DATE------- ---------- Alterations and/or recommendations-------------------------- ------------- ------- ------ ----- __________ _ _ r__ -----.___------- _ -__------------_ r �__-x______________ __________c_.___..__..__._ .__Sl�...-___-_____- -____ --_-__-----------__-_--_._____.----_----_.._--_--______--.-----___- ___-----____---_____--.__ -------------------------------------------------------------------------------------------------------------- ----------------,._____-__-_--_--_---_-_------.--.----------------------_______-_-__---_--_--______----_.----- I --------------------- ___________ ------_--------------------_-----------------------_------------------------------------_____________________________________________ ___ J rxFINAL INSPECTIONBY:----?1 -2-, --- ------------------- Date-------- - ------- ------------------ SAN ------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 . Revises 1.57 F.P.CO.