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FOR OFFICE USE: map, APPLICATION FQR SAINITATION PERMIT Permit No. . - __$-_!- (Complete in Duplicate) � --._.. This Permit Expires 1 Year From Date Issued Date Issued ----_____- , - Application 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. JOBADDRESS AND CATIO --•---•-------- 7�-a-0-------------- i ---------------------------------------------------------------------- Owner's Name------- - - // Phone.--..------------------------------ Address------------------- -�` ` _ Contractor's Name--__-.-_. Zf. .__.____ --------------------------------•- --------------- ---------------- Phone---•----------------_ -•---------- Installation will serve: Residence U,/Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ---).-- Number of bedrooms- Number of baths .�ot size _________________________ -------------------------------- Water Supply: Public system ❑ Community system ❑ Privateepth to Water TableJ�L ft. _ Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe{"rdpan ❑ Previous Application Made: (If yes,date....................) No [�— New Construction: Yes ❑ No Cj _-PFft"/VA: Yes ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: ' J (No septic tank or cesspool permitted if public sewer .is available within 200 feet.) `s ;, 1%, Septic Tank: Distance from nearest well-----------------Distance from foundation__,;__-----------Material--------------._---------------------------------- p . Li � ----_.Capacity 0 ��//✓ No. of compartmentsSize --------,�----------------- quid dept ------------ P Y---------------------- Disposal Field: Distance from nearest well---------------.-Distance from foundation--------------------Distance to nearest lot line_______-_-.---_-- - Number of lines-----------------------------------Length of each line------------------------------ Width f trench.------------- ------ Type of filter material-------------------------Depth of filter material------_----------------Total length-.`__ y- ___-.--__--_-_-.-_------ r f C? i I" Sespae --Pit Distance to .nearest well--_�-___-----Distance m foundation- ---------------- Distance to nearest lot h,ne_.__ --_.-.__.__ 7/ivumber of`pits....�-._____Lining material- (ce____-_Size:-Diameter__�_�'..__..,-_.Depfn=____O--__. Cesspool: Distance-from-nearest well-----------------Distance from foundation--------------------.Lining material-_____x__..---_-----------._-_. Size: Diameter--------------------------------------De th-------------------------------•------------ ----- gals. ❑ p _Liquid Capacity------------------�-_---- Privy: -Distance from nearest well---_---.-__-.-.-.----. r ' ----------- - Distance from nearest building-------------------------- --------- ,. ❑ �. Distance to nearest lot line----�-� .—------- ----------------- -----------T-----4------ -------------------------------------------------------------------------- r Remodeling and/or repairing (describe)------------------- ,� -------------------------------------- ---------------------------------------=---------------------•--------------------- -------------------------------------•------------------------------- -_P I hereby certify f6at'I'haGe prepared-this-application and'tkat-theJwork-will'-b6--dbt e-in accordan a with San Joaquin County ordinances, State law , and rules and regulations of the San Joaquin Local Health District. (Signed)------------A4_' - B -------------- ------------------------------------------------- -•---- f''�'(Owner and/or Contractor) ---- By: �= �f ---------------------------- -------------(T e) - itl (Plot plan, showing size of I ocat on of system in relation o wells, buildings, etc., can be placed on reverse side).! "` FOR DEPARTMENT USE ONLY i APPLICATION ACCEPTED BY---- G��---- -- ---7_ DATI ATE-_!w ------------------------ REVIEWEDBY--------------------------------------------- ---- ---- ---- -----------/--------- -------------------------------------- DATE----- ------•----------- IBUILDING PERMIT ISSUED---------------------------------------------------------------- ------------------------------------- DATE----------------------7--------------------- Alterations and or eco.. _.I ons- - ---- - -----�--------------------------------- ----------------------------------------------------------------------------------- --------------------------- c,,� ------ � n `ice' 4 -' ?----4-6------------------- ------------------------•--- ---------- ---------- ---------------------------------------- ---------- ---- -----------------------------------------------------------------------------------------------------------------------------------..._ FINAL INSPECTION BY:-f ------- -�!'� - Date-------------- / ---- ---------------=4--------------- ---- ------------ --- -- --------------- -- -- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Ha:ellon Ave. 0 West Oak Street , , ` 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California