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FOR OFFICE USE: - /E �. ----------� / r � aa�J� -------------------------------=---------t:�----- APPLICATIOICEDR..SANITATION P Permit No. ....................... --------------------------------------------------------- (Complete in Duplicate) --------------------------------------------------- This Permit Expires 1 Year From Date Issue to Issued _r. '__.� 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. JOB ADDRESS AND LOCATION --------------+--•----------------------- ------- F Owner's Name 'c -------- ---------------------------------------------- Phone--------------------------•-------- 1 Address-_ ) el:7 ° �"Y----cZ— ,_ ..----- � ------ --------------------•--•--------------------------------- t `honeContractor's Name- ------------------- ------ �- = E Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ` Number of living units: Number of bedrooms _:Number of baths -Z_—_ Lot size ----t__�..__. --------------- t l Water Supply: Public system ❑ Community system ❑ Private K Depth to Water Table t. Character�of*soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam [] Clay Loam [ lay [❑ Adobe❑ Hardpan ❑ t Previous Application Made: (if yes,date-.---------_--------) No New Construction: Yes 2---No ❑ FHA/VA, Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic T nk: Distance from nearest well--- ...Distance from foundation-----//4? _.Maternal— ------------------------------- h —_.-�-_ _..-- j 'rl / R ;.[___Liquid de th_____---L4 .Z`_____Ca acit No.'of compartments Size- _ q l6 p y- r . Xf�r .� ti 74 p1 Disposal ;ield: Distance from nearest well__�____�-----Distaice-'Irom foundation________.______. .Distance to nearest lot line-----S________ Number of lines-------.---------------__ Length of each line- �_� �__ `Q�.Width of trenIF ch_._.__ _,_._----_--------_-_- f Type of filter material-4'7_4f&Al,� epth of filter material-------/,�f/__Total length_ Seepage Pit: Distance pto�nearest --_Distance from foundation---l_U.........Distancq jo nearest lot line----` ll Number of pits-______� ___.___Lining material ( iz�: Diamet r._ a,, ..__..___Depth_ Z_- "f , k Cesspool: Distance from nearest well--------- -------Distance from foundstion-----_-_-_-------.Lining ❑ E materia!______________________________ _____ Size: Diameter----------------- ---- ---- --------Depth--------------------- - - ____tr Liquid Capacity—.-----------------------9als.-. Privy: Distance from nearest well _____________________________-------------------Distance from nearest building -------- ❑ Distance to nearest lot line ---------------------------------------------------`---------------------------- --------- ------------------- - -------- '-� � IJ • Remodeling and/or repairing (describe}:_..` � � -�_---- - C��-- ---------- = ------------------------------------------------------------------------------------------------------------------------------------------------ --------------- ----------------------------------------------------------- -�. --- ! hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State?la nd les and regulations of the San Joaquin Local Health District. ) (Signed)------�-- ---- 6------ --------- ------- ---- --------------------- ---------------------------------------------- .{Owner and/or Contractor) By:._..--------------------------------------------i----------`------- - ----- ------------------------------------------ )Title)----------------------------------------`� - -�------ - ---- (Plot'plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY --------- �`- ----------------------- - DATE - f REVIEWED BY------------------------------------------------- --------------------- ---------------------------------------------- DATE----- ----------------------------------------------------- - --------------------- BUILDINGPERMIT ISSUED----------------------------------------------------------------- --------------*-------------------- DATE------------------------------------------------------------ Alterations and/or recomrrie �tions:--------- 43 .?7.), : -'c = , ------------------ 7-�' ------------ V2, ------ ------ ----- a ------------ ................................ ---------------------------------- ---------------- ----- -- --------------------- --------------- ---------- � . FINAL INSPECTION BY:- ---- -----• ;------- - ----- -- ------ Date-------� - -- -------------6---'-::--------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT. 1601 E.ffa:ellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California