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y } Q '_KATION FO:R- SANITATION PERT Permit Na. .___S_f�_3__---_- !� "�00 (Comp in Duplicate) b v �, ,3 �, . 3. Date Issued.___. _:__/s-r ! T � i Application i 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 CATION--•--------`--`--------_ b Owrier`s Name r _ Phone ; Addr s_ es ---------------•------- `= w2.?rte I u S � ....._.... Contractor's Name- 3._.....e: :.=-- =1L2. v� _:7. -------- Phone./ fG :, - Installation will serve: Residence f.,)Npartment Huse ❑ Commercial ❑ T'ailWtourt- ❑ Motel ❑ Other ❑ . Number of living units: ' _ Number of bedrooms _ ._. Number of baths ___ L1 size ��--��c�:_. ----------------------- I ----- "Supply: Public systen-ii Community syste}m ❑' Private ❑ Depth to Water Table ft. Character of soil to a .depth df 3 feet Sand.] G-avel ❑ Sandy Loam ❑ Clay Lo m ❑ lay ❑ Adobe Hardpan;❑ I Previous Application Made: Yes ❑IF to .New onsfruction: Yes 0`Nom' F ANA:.jes ❑ Nogg - i TYP11 E OF INSTALLATION AD SPECIFICATIONS: � (No septic tank or,ceus ool pqrmitfed ffpubli' sewer is available within,200.feet. 1 I .5. 1. SYpos, • Tank: Distance from nearest weld ____-. l ,.Distance from foundafion---------- ____.M dteiial---------------------------------------------------- N6_ _______:_____-__---_____ -.----_____-____. 1 �y No_ of cl+partments----- 1 r?e --- _ Lis;u�d depth --------:-Capacity------------- nce from Dal_ lel Distance�t�rom nearest-well-- -_ _------_Lenath of each line__anon_--_-_----..•_,.-----With ofnCe ttrenchest loft--------------------------- line__---_.-.-'..:-- ' ---- Number o lines__ E ------------- Type _ g !1 ✓ TYPe of filter material___'j_________________Depth of filter maferiT=�__.____- Total length_,_.__. _____ { _- - - i� LL�L See a e Pit: Dista ce to.nearest well - Distance m f ndation� .. Distance to nearest lot line.h__ _ f___-_ P 9 r Numl;aer of pits.:__ _______ _..Loring ma#oriel: _-Si" biameter....' -----------.Depfh__,�-5 � - � r Cesspool: Dista'cerom nearest well_______________Distance from"foundation---____-___-...____.Lining material----------------------------..-.._.. Size: D3amefer________________ ..._Li Paid Capacity als. [] Depth: `m Priv;yi Distance.from nearest well Dasfa ce from br, re budding :______________- [ -. Distance'to nearest lot line - ---- -------------------------------------------- Remodeling anti/or repairing (describe)- � � � i _ ------ --------------------------------- --------------------------------------------------------------- -----\ ----- . r i ------••----------- ------------- ---------- F-------------•-- --------------------- --- �; ------------------------ -•-•----•-•- --------•------------;------- ------•- - - - ------------ - _ -- •--•------- - - -----•----- f _4 - 1 I hereby:certify thatd-have prepared this'application-and that the work wrilh be donesin-ac rdance with San Joaquin Cou ordinances, St: b laws 'a d rul s and regulations of A Saq Joaquin Local Heath District. 1 1.s � f (signed) ._... L'� J ------------------------ -----(Owner and/or Contractor) !� By:................. - --- ------------------------------------(Title) - ------------------•-------------•------------ (Plot plan, showing size of lot, location;of system relation to wells, buildings,.etc., can be p""lac d on reverse side). i n + �I �..:_.�,.-,FtDR�Db�'A"1�7A�i ERY"lT5E�'I�LY:,_.�,�....._;_:.•�.<y:f APPLICATION ACCEPTED BY---------------- -- - ---------------- DATE----- -------•----- l •. --•-- l -------- -- REVIEWEDBY-----------==-•---------------------- =--------••-------------------------------••---•--• DATE ........................ BUILDING PERMIT ISSUED--------------_ t _ D ARe'rations and/or recommendations:---- --------------------•------------------------------------------------------ ---------- -- ----- •-•-------------------••--=--•---.... EI ------••---•---•---------•----------------------•-• --- -------------- --------------------- --- ------------ - - --------------------------- --------- E, _____________________«..-..____ _......__.._______ _ __-_ _ _ _ ___ _ __ _ __ ________..........-------------..__-___ r _ I _____________ _______ _ __ _ -------.-.--._______._____--__--._______--___- ____ FINAL INSPECTION BY: .__ -:- C-/-----------------=-------=------- Date---=-- -`- = SAN JOAQUIN LOCAL HEALTH DISTRICT i . 130 South American Street 300 West Oak Street- 132 Sycamore Street-''_ 814 North "C" Street re -, ; Stockton, California Lodi, California Manteca, California Tracy, California ' ES-9-2M , Revised 1.57 F.P,CO. f l I.