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JCATION FOR SANITATION PEI T Permit No. _J-__--_`----__(. (Complete in Duplicate) �•�2 ,� % Application is hereby made to the San Joaquin Local Health District for a permit to constr4ainsta erein described. This application is made in compliance with County Ordin ce No. S49 JOB ADDRESS AND O ON.-'-- .. -P- ?;l-� _CLs�C - �.'L ,/ - Owner's Name '_ -L1S,./.C. - ve t �-� Phone..L!__...._.__C�. 7� Address J' Q. c C��`' ( ��_2�v-------- Contractor's Name------------- -L,�'-_------ — .. ... --- ------ Phone 0 6 �� Installation will serve: Residence ❑ Apartment House ❑ Commercia Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -------- Number of bedrooms -------- Number of baths __ Lot size ___- --------- --------- Water Supply: Public system X Community system ❑ Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑ No ❑ New Construction: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public s)ewer is available within 200 feet.) J Sep is Tank: Distance from neaarres�ell.f--V--------Distance� rom found tion-�d_1.. _......Mateer al_.�� yj`�'--'-� ---------------- No. of copa ................_Size_i%_._.-Q�.-/-Wl!iquid depth_//S.-...._.___---Capacity_,��D..___.-__ Disposal Field: Distance from neare/�t well. _)OIDisfance from foundation-_ __.._.Distance to nearest lot line____ . -V - _Length of each line._.-r�..............Width of trench.. ��_.__...._..___.___ j Number of lines._...7----_....___,_i�_.-. .. _ l Type of filter material....k .... -Depth of filter material.._./_(�"_......Total length--------- �_ _�__________________� See a e Pit: Distance to nearest well ---------Distance from foundation__�.�'..D' cue to nearest lot line----- a_._.... Number of pits._.._.._..._...._Lining material.�% ti-/_..Size: Diameter.� ..�...___Depth_ . " Cesspool: Distance from nearest well______________-_Distance from foundation..------------------Lining material_...__ rPriv❑ Size: Diameter.--- --_-------------_------------ Depth------------------------------------------------ ...Liquid Capacity---------------------------gals. 4-- Privy: y: Distance from nearest well.................................................Distance from nearest building---------------------- -------- .--- __------ . ❑ Distance to nearest lot line---------------------------------- ---------------------------------------------------'---•--------------------_--- ........ Rem Jelin and/or repairing (describe):.....,../ � o�/ = �`?4•s`•'',•-1�2t'-`'-a_L _!- w _ �D �T._ 1 rf�: •l. _l tr..cr_-----. ----- ---------------- I hereby certify that I hav,, prepared th's application and that the work will be done in accordance with San Joaq in Count ordinances, Sfate.laws, and rues an regulations of jlaf* n Joaquin Local Health District. (Signed) { ................. - -- -------- ............... -( Contractor) 7 ------------ (Plot plan, showing size of lot, location of system in ro wells, buildings, c., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -�.�___^_.........................".--_----------- ------------------------ DATE-�------------_--------- .-------------------- x REVIEWEDBY------------------------ `' DATE --%_7...--••'--------•--•----'-••-•-•-------•---- BUILDINGPERMIT ISSUED----------�--,----------------------------------------------•----- -----------------.- DATE.............r •------------------------------------------- Alterations and/or recommendations:-------------------------------------------r: --•...---'•-•--- --"-••-----•-------••-•-•-----------•'•-•-•---••---• ., ----- -••----•-------- ----------------------------------------------------------------------------------------------------------------- . ---•----------- --•---------•-- ......------....---------•-----'-•--------------•--------•......•---- -------------- - --- -------- ------------------- --- --- -- ------------------ --------------- --------------•--------•----••• .......... _ .. Date-- ...... ..------ - .." FINAL INSPECTION BY:.... i" - r SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M : Revised W-2100