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3 � �i � UCATION FOR SANITATION PERF Permit No. J, 3 (� h v (Complete in Duplicate) Date Issued _ - '-a�-4 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 finance No. 549. J OB �� C�� ADDRESS AND LOCATION------------------- -----=-----------------, k--- �' ----• - ----------- ------------- ------------ Owners 1Name__. --- ------------ ------------------- --- -------- - ----- ------- - - - ------------ Phone Address---------- -------- --------- ontractor`s Name ------- ---- ------ ----- Phone_-----•---•--- ' - Installation will serve: Residence ❑ Apartment House ❑ .Commercial 'll ❑ Trailer Court ❑ Motel ❑ OtherEl Number of living units: _______: Number of bedrooms _-___-- Number of 'baths __:__:_ Cot size __ ___________________ ..•_--_----------- f Water Supply: Public system ❑ Community system ❑ Private ❑ Depth to Water Table -------- ft. I Character,of soil to a depth of 3.feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam,❑ Clay ❑ Adobe❑ .,Hardpan ❑i Previous Application Made: Yes ❑ No ❑ New Construction: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS I (No septic tank or cesspool.perm itted if public sewer is available within:200 feet.) P � . Se tic Tank: Distance .from nearest we}l_________________Distance from fou'dation___:-..____--______-Material____________.__:____.____ ❑ No.'of.compartments--- ,---------------.....Size--------------------------------Liquid depth------------- ---------- Capacity.-J! - -- Disposal Field: Distance from nearest well_________________Distance from foundation--------::-_-_:__:___Distance to nearest lot line--i- ElNumber of lines-------- ---•-- - ------Length of each line----------------=--------------Width of trench ------• ____. -- ------•--- Type of filter material-------------------------Depth of filter,material---------- --------------Total length--.....----------------------- ,--•_---, to Seepage Pit: Number of 'its rest well_---= Lining maDteraalce from foundation Diamefier------------------------ be Distance to nearest lot Im ------------ Pj_--_______,. pth f - ------ Cesspool: Distance from nearest Distance from foundation____________________Lining material.----------------- I ❑ Size: Diameter_. == =:Depth----------------------------------------------------Liquid Capacity �� gaffs. Privy: Distance from nearest well-------------------- ----------- Distance from nearest b luij&ng_= --->'----_----___-- ❑ Distance to,nearest lot line_____- ----------- --------------------------------------------------------- Remodeling and/or repairing (descr.ibe) --------:____ ` ---------------------------------------- /---------------------- ---------------------------------I-------------- -------------+ ` ------------- I -------- -------- ------------- - - - .. ----- ------------------------------------------ t F ----------- herebycertify that I have re ared this a iication and fhat the work will be done fn accordance with San Joaquin County, P P RP ordinances., State .law's, and rules and'regulations of the San Joaquin.Local Health.District. ---------------------- (Signed) e'i: ! ---- - ((Owner an /or hC' on tract or) By - --------- ------- -(Title)-------------------------------------- . ---- ------- -=-------------••--- (Plot,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-- ----- -------- ----- DATE A E BUILDWED 6Y =-- -------- ---- - --------------------- DATE__ — i ----------------- REVIEWED _ - ING PERMIT ISSUED -- ----- --- �" - DAT - ---- ---� ------ --- - �I Alterations and/or recommendations:-_ Pi ----------------------------------------------_Yy`f- t� '_=---- - ----------------------------------------- ` -- ------- -------- --------- -----------'------ �- ---------------- ----- --------- 12,10 -� --------------- -- ----- FINAL INSPECTION $Y: - ------- ---- = Date ------------- --------------- SAN JOAQUIN LOCAL-HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Streef 814 North "C" S}ieet Stockton, California Lodi, California Manteca', California Tracy, California' FS-4-21A 8-51. Revised W-2100 y, i