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I- FQR OFFICE USE:E-.�: ------ - ------ No.--'t' .__-- AppLICATIQN FOS 'SANITAiION PERMIT Permit No. ........ ....�..... . ... k - ----------- (Complete in Duplicate) Date issued .i ------ --------._- This Permit Expires 1 Year From Date Issued - Application is hereby made to the San 'Joaquin Local Health District for a permit to construct and install the work herein described. t This application is made in compliance with County Ordinance No. 549. t , �/ = x l JOB ADDRESS AND�OCAON q- Owner's Name W� _ _ Phone��- al..Q Address--------------------------------- - --- ---------------------------- --------------------------------------...... -•----------------------------------------- ----------------------- Contractor's Name '----• -------•-•-----`-------------------------------- •-------------------•------' Phone / f Installation will serve: Residence Rartmenf House E] Commercial E] Trailer Court ❑ Motel ❑ Other EDy ._ , // Number of living units: /._-., Number,of bedrooms __.Number of baths.- D9.________... i Water Supply: Public system V C mm unify,system ❑ Private ❑ . Depth•'to Water Table40_ ft. Character of soil to a depth of 3 feet:- Sand C] {Giavel E] Sandy Loam ❑ Clay Loam ❑i Clay ❑ Adobe Hardpan ❑ Previous Application Made: (If yes,`date.._=''-------------- I No ❑ New Construction: Yes E]. ,No >'' FHA/VA.- Yes E] No E] t TYPE OF INSTALLATION AND SPECIFICATIONS: I , ` {Na septic tank or cesspool perfnit+ed if public sewer is available within 200 feet.) i .' ! Ss tic Tank: Distance from nearest well..____'___- -_Distance from foundation--.________-.--___.Material------:_._;------------------------------------ No. of compartments-------------------------Size---------------------=------ ---Liquid depth--------------------- Capacity __. a oqI Field: Distance from nearest well--------------._-Distance from foundation------- to nearest lottline__`_n°:___-____- �T Number of lines-----------------------------------Length of each line----------------- of trench.-- `- ---- -'---------- 0 _. Type.of filter material________________ _ __ Depth of filter materia$____.___-_._----_�__-:Total ,length___._----_F--------------------- ___ _-. ,.__.�__._ i Distance from f ndation__ __$-_______..Distance to nearest lot line_...5....... - Seepage Pit: - Dis#ante to nearest well-/� __ Linin material--,? __.Size: Diameter---3_saJ-------------Depth_-_--R_Z._ Number of pits-----/----------- gn P , Cess ool: Distance from nearest well-----------------Distance from foundation---------.-----------Lining material_-_.___.___.-._-___.________._.._. Q Size: Diameter -------Depth--------------------- •---------------------- Liquid Capacity... gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building------ ---____-__---._ [] Distance to nearest lot line------------------------------ ---------- -------------------------' --------`----- Remodeling and/or repairin' .(describe)-------- ------------------------------ --------------------•-------------•-•-------------------------------------------•-- ,---------------.. t•---------------------------------------------- ------------ ------------•-:--------=---------------------- ----------------------------------------------------------------------- =------------------------------------------------------------------------------------•---=------------••-----------•-----------•-----------------------•--------------------------------------------------------------- I hereby certify that I have prepared this application and that'the work will be-done in accordance with San Joaquin County ordinances, S a+ laws, and rules and regulations of the San Joaquin,Local.Heal+h District. t ` (Signed)---- ------------- - - - ------ ----- --= ------= , = {Own r and/or Co ctor) t `--- l e . ' g --- -,. _(Title) ..------------------ (Plot plan, showing size of lot, location of sys+em in.rela to wells, buildings,.etc.;can be placed on reverse side). 4 FOR DEPARTMENT USE ONLY -= -- -- ---------------- -� ----------- ------ - APPLICATION ACCEPTED 8Y.___-_-'-- .- ---------------------- DATE--___-'- ---------------- REVIEWEDBY-----------------------------------'-------------`--------- ----- --------- ' DATE BUILDING PERMIT ISSUED-------------------- - 7 -------DATE:----------==-------------------- _--'-----r---------------- Alterations and/or recom ndatio s:- --'-' ----- �- ,,ZZ?? ` ----------------------- `---------- -------------' ' _'� .�, -'- r <' -` ` ---------•-------•--•---------•---------•---•------------------- -------------- --------- a } --••-•---------------------------•--------------------•--------------- =------------------------------------------- ----------•------------------------------•-------------------------------------------- ' I ---------•-------------------------•---------- ------------------- ------- -------------------------' FINALINSPECTION BY:-- --------�> ----------- ---•-- ------------- DateZ:.Z=� -'-------------------------------------------- a SAN JOAQUIN LOCAL HEALTH DISTRICT g 1601 E.Ha:ehon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,'California Lodi,California ♦ ' . Manteca,California Tracy,California � � Efi 9 REVISED 8-59 3M-3-'83 F.P.CD. F