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'�� '��.. �,; :�" ��'""�'��`-- x*.� ' ��-,-�-.alt � �,a•�.�� C ,ARM PPLICATION FOR SANITATION�PEiT " Permit No. ----_ �-----. " ' "° (Complete in Duplicate) rt �` c�/ oj r Date Issued ./!al 7---- " 1 ?3— t 6V -(D 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. 549. *4� _.._ - - �,,._„ � Qom// /J JOB ADDRESS AND LOCATION_----------------- ----V -- � Aw �° Owner's Name -------- l hone ry. Address--...... -•••'----•:• .. e4 _- --------- - --P J� 4, Contractors Name---------------J ce ___�____._ -------i ------------------------- 4 --._._ Phone G_ "- Installation will serve: ,ReAence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel'FIE-f�..Other Number of living units: -------- Number of bedrooms -------- Number of baths ------ Lot size -- -------------------------------------------------------- ' 4 Water Supply: Public;system'❑ Community-system'—❑--Priva;te.Depth to Water Tabled- ft. Character of soil to a depth of 3 feet: 'Sand [] Gravel 0 Sandy Loam Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: Yes�p`� N64 'f-New Consfruction..-Yes ❑,,QLNo TYPE"OF INSTALLATION AND SPECIFICATIONS: .� (No septic tank or cesspoo p rmitte if public sewer is availab!within 200 feet.) ti ank: Distance from nearest well-----------------Distance from foundation--------------------Material ----------------_.---- --------__-.---.-__----- No."of compartments Size t `--- ---- ----�-----tLiquid depth""-' Capacity I Field: Distance from nearest we€i__'_----------- _Distance from foundation--------------------Distance to nearest lot line----------------- Number of lines-------------- Length. of each line-----------------------------.Width of trench----------------------------------- Type of filter material-------------------------Depth of jilter'material--------------------_.Total length------------------------------------------ r i `� r .y '1 / ./ / O Seepage it: Distance to nearest well_/------------------Distar~ce o" foundation_ -.- ...---.Dis c`to nearest lot cine---__------------ a Number of its-3. Lining material. �'�k-Size: Diameter--_- ---Dept h-----�----------------- i Cesspool: Distance 'from nearest well-----_-----_-_-Distance from foundation-------------E-----.Lining material-_.--_.-._-_-.-_---_--------_----.-. ❑ Size: Diameter----------------------------- ---------Depth----------------- ---------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well----------------:-------------------------- f_Distance from nearest building-------------------------___________---. • ❑ Distance"to'near`est I"ot"line---- 1 - Remodeling and/or repairing (describe)---------------------------=--------:------------------------------------------------------------ -------------•----------------•-----------------•-•-. i l -------------------------------------------------------------------------------------------------------------------------------------------------- -- ....------------•--•------------------------ 1 .i . -----------------------------------------------------------•- - -----------------------------------------------------•----------•--•-----•-------------------------------------••--------------------" 4 I hereby crl I have prepared this application and that the work will be done in accordance with San Joaquin-County ordinances, St d rules an regulati of the San Joaquin Local Health District. Si ned[ 9 )-------------- -------------------- caner and/or Contractor] By: - y-1 _ fl „ ..�.---- [Title) • = ---------------- -- - - --------------------------------------- --- - -- [Plot plan, showing size of lot, "location of system in relation wells, buildings, etc., can be placed on reverse side)., FOR DEPARTMENT USE ONLY j APPLICATION ACCEPTED BY---------------- --------- ---- -- -- --------•------------------------------- DATE t I ti REVIEWED BY -- --�--------------------• - DATE-- ` --- - - BUILDING PERMIT ISSUED-----... = J-:---- ------ DATE-------- --------------- -- Alterations and/or recommendations-------------------- _---------_ -- ----•------------------ --------- - --- - -- - - ---- --- --• •------------- -f--- - --'"/-• -------- {-- -------------------------------•--•-------•------- LO "INSPECTIOiI 5 ----- "INAL 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 f