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ire APPLiCATI Permit No. __. _!____....__ . ,SIV FOR SANITATION PERMfT (Complete in.Duplicate) ni; Date Issued --- r�0 A'i`licMaTI as i by ma a fc` aan f}�' i,Joaquin Local H6alth District for a pei mif.to construct and install the work herein described. i,T�s ap hca+,nnJi. 'c a-in orripliance with CountyiOrdinance No. 549. J01� DDI ESS l��fl Ti . . ---------------------- -- y -- ---- ---- - --- ---:--------------------- -------------------- Owner's Name--------------------i�'. _ Phone__ - - --------------------- -- II Address--------- ----------------------------------------------------------------•-•-------------------------------------------------------• -•-•--------------------------------- Contractor's Name------- p 0-721-4--------------------•-------------------------------------------------------------------•---------------------- Phone..------.._..-- ------------------- Installation will serve: Res'l ence [q00`Apartment .House 0 Commercial ❑ Tr •ler Court ❑ Motel Other [ ", �.. �� Number of living units:�.___ N bar of k�edr'ooms _�, Number of baths _______ Lot size __ ________ ____________.,___________----_---__-__.______ Water Supply: Public sys411 m Community system ❑ Private ❑ Depth to Water Table -------- ft. `* Character of soil to a depth of 3 feet: Sand ❑ Gravel.E] Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Pef:Pirdpan ❑ Previous Application Made: Yes ❑ No [New Construction: Yes ❑ No 2000'FHA/VA.. Yes ❑ No ®/ i TYPE OF INSTALLATION LAND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic T nk�. Distan 1p from nearest well_________________Distance from foundation-------------------.Material______--___________________.._.______.__----.. ❑ o. ofCompartments--------------------------Size----....------------------------Liquid depth------------ - - ---------Capacity-----------------�-,- Disposal Fields Distance from nearest well_t eDistance from foundation__r,J____--_-Distance to nearest lot line_______ I rrs- ❑ umbe of lines-----------------------------------Length of each line------------------------------Width of trench------------------------------ + ype o' filter material-------------------- _------Depth of filter material length___ _-______..________-_-__--_ _-_-- Seepa Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line-------.--------- l3 ❑ Numbil� of pits----------------- --Lining material-----------------------Size: Diameter-----------------------Depth--------------------------------- Cesspool: Distanee from nearest well-----------------Distance from foundation----------:---------Lining material-------------------------------------- m (� Size: Dliaeter--- ---------------De th-------------------- gals. El �Nl p ----- ------------Liquid Capacity g Privy: Distanoe from nearest well___----------------------------------------------Distance from nearest building--------------------------------------.-._. ❑ Distanee to nearest lot lire--------------------------------------------- - ----------------------- --------------------------------- ------------------------------- �Re odeling and/or re airing (describe):__-___ _ ______________ __ , ----- -- 1 --- -- __ I-------- - -- 5, - 1.11 ----------------------------------------•------------------------------------------------------------------------------------------------------------------------------ _--_--.__I ----- that I have prepared this application and that the workwill be done-----------------------------------• ------------------------------ ar - --------- --- --- - ----- - ---------------------------•------------------ e in accordance with San Joaquin County ordinances, State laws, anis rules and regulations of the San Joaquin Local Health District. e,_ �---------------------------------------------------------Owner and/or Contractor /Signed Y°!=��,��----- -.`-- ��.""-=------�------- By:----------- ------------------•---_--•--•--------------------- Title ---- (Plot plan, showing size of Ilot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY------- ----------- ----- ----------------------------=------------------------------------------ DATE------------------------------------------------------------ REVIEWEDBY-------------------Il'----------------------- ----- --- -- ----- -------------------------------------------------------- DATE---------------------------- ---------- BUILDING PERMIT ISSUED--------------------- ------ -- ----------------- ------------------------------------- DATE---------'-- '•- Alterations and/or recomrr�i ndations: - -------� -------0-------- --- ------------------------------•-----------------------------------------••---•--------------------------------------------------- --------------------------------------------;III ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ 1�-! ----------------------------• ---------------------------------------------------------------------- --------------------------------------------- ------------------------------------------ ------ ------------------------------------- ------------------------------ FINAL INSPECTION BY:- -- --------- -- -J---- f Date-------------- --------(----------- ------------------------ I SAN JOAQUIN LOCAL LTH DISTRICT 130 South American Stres# 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M ReviseG 1-5 F.P.Co. 4