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?.rPI_ICATION FOR SANITATION PD%AT Permit No...1J.C+t (Complete in Duplicate) V Date Issued .-../-........_ Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. "sis application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND .CATON�..-.-r2-..t y!t/------ =-c Fr'` _-� �jG ( / - - - 1 °. - f K ----' ----- --- --- -....... -......, Owner's Name .. t... aa._i- f Phone Contractor's Name --------- ----------------------------------------------------------------------------------------------------------- rnone ----------------------------------- Installation will serve: Residence ❑ Apartment House ❑ Commercial)X Trailer Court ❑ Motel ❑ Other ❑ Number of living units:.Q.. Number of bedroomse----- Number of baths _J.. Lot size ...- ................._--.- Water Supply: Public system ❑ Community system ❑ Private Depth to Water Tabled -e ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobex Hardpan ❑ Previous Application Made: Yes ❑ NOX New Construction: Yesx No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) eptic nk: Distance from nearest well -------_-------- Distance from foundation....._.............Material-.__.......-----._._........._.__......... / t., No. of compartments------------------.... Size --------------------------- ---Liquid depth ------------------------- Capacity ----- -------------- ,sposa eld: Distance from nearest well --------- -------- Distance from foundation. ---------------- ...Distance to nearest lot line................. Number of lines._ ------------------- ------------ -Length of each line ............ _.._.-..... .... Width of trench ........ ...._--_-------.-------_ ((( Type of filter material ------ ..... Depth of filter material ....-__..._.-------- Total length ---- _..........._....................... Seepage Pit: Distance to nearest well....%� .-.... Distance from fAndation......1k.--........ Distance to nearest lot line ---.a......---.. Number of pits ..... /-._.-......... ming materia�Z- l.....Size: Diameter--,il0� ............. Depth------- �-_------------- Cesspool: Distance from nearest well ----------------- Distance from foundation --- _---------_-...Lining material ------------------------------------- El Size: Diameter ------- ------------------------------ Depth ................ --------------- _-._-----------Liquid Capacity ---------_-'.............. gals. Privy: Distance from nearest well --- ------- .------------------------------------- Distance from nearest building ---- _-------. ❑ Distance to nearest lot line_ ---------- ------------ ----..-.----.--..... ..-� . - r RemodelA and/or repairing-.fd�2C- ------- ---------------------- - - --------------------------------------------------------- - - - - - - - - I hereby cert' that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Sta}e'aws, aqd rules and regulations of +he San Joaquin Local Health District. Contractor) By: - '--------------------------------------------------------------- ------ - - - ----------- (Plot plan, showing fize of lot, location of system in relation to wells, buildings, etc., can be placed on revetc FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY. REVIEWED BY ---------------- ----------- BUILDING PERMIT ISSUED....... FINN 130 South American Street Stockton, California ES -4-2M 10-52 Revised W-2100 -------------- - I 4-, °3AN JOAQUIN LOCAL HEALTH DISTRICT 300 West Oak Street 132 Sycamore Street Lodi, California Manteca, California 814 North "C" Sf,eef Tracy, California S il I< C , r