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A` �IICATION FOR SANITATION PER' 'T Permit No. -40-16..._.. (Complete in Duplicate) Date Issued /Q��K. 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 Ordinance No. 549. _ JOB ADDRESS AND L CATION -- -- -1 M: _V4,r( - - - Owner's Name-------------- - '• - -..-..._ Phone .r Address.-_— - - --------- -------------------- Contractor's Name---------------------- ----- -- -- --- ---- Phone........ . ...... ..__----- - Installation will serve: Residence Apartment House ❑g Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _---_-_ Number of bedrooms -ov°—Number of aths .... _. Lot size _--a-- -_`7t.__ ____ _._._.._._ - -- ----. Water Supply: Public system In Community system ❑ Private [ of to Water Table ft. Character of soil to a depth of 3 feet: Sand P Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe PP*'0Hardpan ❑� Previous Application Made: Yes ❑ No VNew Construction: Yes ❑ No ®� r� TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 fee/t.)} O Septic Tank: Distance from nearest well. __ istance from foundation_____1P.. _F.__-Material-_________________......-_._____--__--._.__ ❑ No. of compartments-------_--/-_--------Size--- --r_-.-`Liquid �d/ph____--__-------------Capacity-----_-- .__._. Disposal Field: Distance from nearest well-_W_�-.Distance from foundation__--___<f0_ _,Distance to nearest lot line-------- ----- Number of lines............... ❑ V_ Length of each line------------7.5.._.r_.__.Width of +ranch...-.____1_`?_'_-_ Type of filter material___-__--- rk,Li_Depth of filter material_..-___tg___._Total length------------ �--------___.__ Seepage Pit: Distance to nearest well--------------_------Distance from foundation-_..................Distance to nearest lot line:_____-_..I ❑ Number of pits-_-__-.--__..._.-_Lining material-.__----_.------------Size: Diameter__....-_---_---_---Depth-_-._-_.___-_-._- Cesspool: Distance from nearest well-------_-___Distance from foundation---__.__-__-Lining material-__.. ❑ Size: Diameter--------------------------------.---Depth---------------------------------------------Liquid Capacity.-------------- Privy: Distance from nearest well-.-_--__-.---_.--___----_..___.----_--.__Distance from nearest building--------------------___❑ Distance to nearest lot line-. __-- _-_. .. .... .. .Remodeling and/or r airing (describe):. _-... w �Jv [-f -------------------------------- ------- . - - - t'tJV - - -------------------------------------------- ------------------------------------------------------------------------------------------- ----- - - -- --- - ---------- ----------------------- ... - - - - —- --------------------------------------------------- - - - ... - - - I hereby certify that have pre ared this application and that the work will be done in accordance with San Joaquin County ordinances, State lavas, and rules an regulatio of a San Jo qui Local Health District. (Signed)----------- _.._ ----_ ----, ___-.- - _. ---------- Owner and/or Contractor By:------------ - ---------.------ '----------------------------------------- --- -------------------------------------(Title)------------------------------------- (Plot plan, showing size of lot, location of system in relatio to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------------------- - --- ----- -----------------------------------_ DATE---------- S4 _y // -- REVIEWED BY - - - - ------------- DATE-------------- ------ - - ---------- BUILDING PERMIT ISSUED------------------------------------------------------------------------------------------... DATE.----------------- ---- - --- - - Alterations and/or recommendations----- ---------------------------... - ------------------- ------........ ------......--..........-------------------------------------------- --- --- --------_-_------------------------......--------------------------------------------------- -------------......---------------------_--------------------- ---------•----------------------------------------------------------------------------------------------------- ------ -----, /-'—/---------------------------------------- ---%----- - (-'-'--------- ------------------- ----------------------------- FINAL INSPECTION BY:-----l-/4!_._!------- ---------------------- Date----= Lei__---/5! --) -- 777 --- --------------------_---- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Sheet 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M 8-51 Revised W-2100.