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r\ ��D v Al"f-m ;ATION FOR SANITATION PERM J Permit No. ....-.._./............. (Complete in Duplicate) Date Issued .... Applica�ion 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. S49. JOB ADDRESS AND Q LO --- . . e --- — -- .. -hone./Y- .....P...9../ Owner's NameZ - ............ ae_ - ------------------------_ ----------------- ---------- Address-_—_c< .:=........_ . ... -------................ .....-...............--------------------P--------- Contractor's Name.----------- ---------� ......... ---------- Phone/Y.a. __i4r --f- Installation will serve: Residence [Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ r Number of living units: .1..�Number of bedrooms .-::-:.. Number of baths �.... Lot size ._1�.0-'�!_/'25----__-_--___.-------._ Water Supply: Public system R Community system ❑ Private ❑ Depth to Water Table .S:D ft Character of soil to a depth of 3 feet: Sand 0 Gravel E] Sandy Loam ❑ Clay Loam ElClay E] Adobe [R—Hardpan ❑ Ly Previous Application Made: Yes ❑ No Ivew Construction: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic T k: Distance from nearest well?�---Distance from foundation... ..__.Materia l._ No. of compartments------_- ..._._...Size_s .X.. �i ._.Liquid deth_ _6.4 ' .% .._ ..-..--. ------ Disposal Field: Distance from nearest wenla?1j0%9-_,"`Distance from foundation...yA--- .Distance to nearest lot line...._........... Number of lines......._._.-//��_... Length of each line--------7-r.-----.__..Width of trench.__,2Y-._..._---------. Type of filter materials .lLl..2e_C..Depth of filter material:...... _9.........Total length......... ---------------------- Seepage • : Distance to nearest well.-)Z0??:t-'�-----Distance from fou dation.-_c. ........ Distance to nearest Iptlin •>.tS�... IBI Number of pits------ -------------Lining material.. .Size: Diameter-----.i.3..........Dept h--- iT Cesspool: Distance from nearest well...........------Distance from foundation.. ------ _--------Lining material--------------------.__..........�, ❑ Size: Diameter. -------....Depth---------------------------------- ----------Liquid Capacity----------------------------gals. Privy: Distance from nearest well----------------------------------- -------------Distance from nearest building------_.-----------------.---.----- �n. ❑ Distance to nearest lot line.. ......_................... ............._ -----------------------------------------_----------------- --------------------------- 1 Remodeling and/or repairing (describe):------------------------------------------------ \' ---------•--....................................................................................................................... ---`---------------------------------------------- . -----------`----------------....-_.........------------ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, StaV ws, and rubles and regulations of the San Joaquin Local Health District. , (Signed)- �/11 + - /f�-f ---------------- - - - -----._.Owner and/or Contractor) I. By:-------........ ...............------- + cs♦.-✓/...... . - /-.-- ... ....------(Tide)----- �- ...... . .... . ... (Plot plan, showing size of lot, location of system in relation to w IIs, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY.. . - ....... - - - ------------------.---- ...... DATE-----.- ----- -- ---------------------------- REVIEWED BY-------------------- ........... - -- ---- --------- -------- . DATE---............... --- -- ---- ------------------------------- - BUILDING PERMIT ISSUEp.......` .... - - - _... DATE---------------Sv Alterations and/or racommen atio :_. ,�- - --- --�--_------------- ...................................... --------- ----------- .._.------------------------------------- ------------------- .............. -- ---........-•------...... .. --- ....._............................ -------------.................................. FINAL INSPECTION BY%_ ....... ............................... ---- Date.... 3- -------_.....__ ..----------------...--------_-_----- SAN JOAQUIN LOCAL HEALTH DISTRICT \�\ 130 South American Stresf 300 Wast Oak Sfreet 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California A.w000