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FOR OFFICE USE: >^ _ n i1 �----- ---' 3� -U f...y. - pp --� _� 5- - __. T3 p APP06AT['ON FOR- SANITATIOWPERMIT Permit No. .. -------------a- 7�-------------------------- (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 Ordi e o. 549. JOB ADDRESS ANDriC ON --------- - ------- 2 - i 4Owner's Name______-- __ ` s ' -------------- Phone4 € .,M..;.�. _ ------------------ Address-- ---------------- ------------------------------------------------------------- / f Contractor's Name = -------- ------= r�-ff -------- ---------------- Phort 9�2- d�� _. Installation will serve: Residence '❑t Apartment House ❑ Commercial ❑ Trailer Court Motel ❑ Other ❑ Number of living units: __..____ Number of bedrooms -------- Number of baths -------- Lotmsize __--.__ - - -- -------- Water Supply: Public system J9 Com,m_un ty system ❑ Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: ,Sand ❑ Gavel ❑ Sandy Loarn ❑ Clay Loam ❑ Clay ❑ Adobe ( Hardpan ❑ F t . l No�- New Construction: Yes ❑� No j�. FHA%VA: Yes ❑ No Previous Application Made: Ilfyes,date.,__:..__...,-- TYPE OF,INSTALLATION AND SPEC IFICA_TIONS: (No septic tank or cesspool permitted if public sewer is available within-200 feet.) Septic Tank: Distance from nearest well________________Distance from foundation'____________t_--.Material---------*._--------___-._________--____-_----. ❑ f1Ci'SAI ' No. of compartments------ ------------s'---Size---------- ---------I---- -----Liquid depth----- Capacity 1 Dis csal Field: Distance from. nearest well-," B,.-Distance from foundation---.l4P______--..Distance to nearest lot line---0-__-.-_.... �. ------------"----- t r �f Number of lines___C—lf :'�.A....Length of each lihe_3-Q_- Width of trench_ _______________________- aa Type of filter.matenaVx_ �_�_I9. .Depth of filter rriaterial__n_J.0 _ ....Total length-----3o__1---------- ____________- Seepage P'st: Distance to nearest well__)VV_/V( r____Distance from foundation___ _ I _4__._.Distance to nearest lot Ime___tJ___.____-- p. g ` g.....----Depth--,?S J= ; ��•-•- � — Number of its.-Q.Aix�'_'___Linin matenal____ -��.:_--.Size: Diameter-___ • 1 111 IF, - `_ f Cesspool; Distance from nearest well----------- _.-_Distance from foundation_L__________________Lining materia4-----------.-.____-._.____--________.__ ❑ Size Diameter--------- ------------ -------------Depth ------`------------- -----------------f---Liquid Capacity-- '-----------------------gals. t Y ', ------- Privy: Distance from-nearest well_____________________�_-_-_.____._.-__._-.--1D�i 'Mance from neatest buil'ding'--�i'' ------------------- ------- �] Distance to nearest lot line---------- -- --- --------- :r,:4_r +h ----- ------------------------ Remodeling and/or repairing (describe):- ---- f - A : --------------- ------------------------It-------•-------------------------------------- -- ------ .----------- ------------ ------ ------- -- ---------- ----------- ------------------------------------- ---- -- ---------------------------------------------------------------- I hereby certify that I have prepared this application�a d thaf-fhe work will be done+in accordance with San Joaquin County ordinances, Sto,certify an rue and irMations of,the San�Joaquin Local Health -a-lth 06 District. (Signed)------_----------------- --- - --,-------`,v (Owner and/or Contractor) ---------------- --------- ,�--`�'-. --- ---- -- {Title) ' ' ---- ---------------------- By: (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be place n reverse side). �+ -FOR,DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -----------------------1. "' Q_ - - DATE f- ---- --(�--'� REVIEWED BY-------- 4' Y ------------------------------------------------------------------- DATE--- - ------------•--------------------------------------------- -- ----------------- - - -------------------:------�`' ' BUILDING PERMIT ISSUED --- DATE ----- -------------'-------------- Alterations and/or recommendations:_____./ - -.l>_g___.__._. �_ ________r9 i --------------------- ;=r'�---- %�� --, �� : --------------------------------------------------------------- ---------------------------------- -------------------------------------- ---------------- ---------------•-------------------- ----------------------------------------- --------------------------------------- _-_-I -------------------------------------- -------'------ - -------------------------------- ------------------- --------------------------------------------- --- ------------------- - ----------------------------- -- -------------------- FINAL INSPECTION BY:. ,7.._L/ --------------- -------------- Date - ' /3� 5 SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haselton Ave. ! 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California } ' Manteca,California 5 a Tracy,California F.P.Ca. =�