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FOR OFFICE USE: APPLICATION OOR SANITATION PERMIT Permit INo. ---l.l .----..-. ----------------- -- -- - ---- ------------------------ (CompleteI _ in Date Issued . ._ -5.. ------ ---------------------------------- a Issued -..-.- This Permit Expires 1 Year From Dat, _ I`. Application is hereby made to the San Joaquin Local Health istrict for a pe it to construct and install the work)) herein described. I This application is made in compliarsce with County Orclipnll No. 549. JOB ADDRESS AND LOCATION----------------- - --- .-- ---------��------"----- - a '1�-ti- ------------------------------- �--}-- Owner's Name ` '-.• ------------------------------------------------- Phone ' lX. - -- --------------- 12� Address-----------------•--- --•------11._T_ 1-------- ------ ------ ------------------------------------------------------------------ I�Contractor's Name .d22� --------�-�� ------- y ------ --------- Phone. i•17- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: A---- Number of bedrooms --------- Number of baths ---!---- Lot size ---------S-----x--N--------------.._-..-.---_-._ Water Supply: Public system X Community system❑ Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ 1Sandy Loam ❑ Clay Loam;f Clay [] Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,+date--- --------------1 No 5"2 New Construction: Yes ❑ No FHA/VA: Yes ❑ NoK s TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted,if public ewer is available within 204 feet.) � t, Septic Tank: Distance from nearest well----- --..Distance from foundation----.1.v------..-Material_,. . � -�c9 ---.- . - ----------- --Liquid de th--.-- --------------Ca acit 0� C]. r �� i No. of compartments-------�------------Size3�X�.-_____•----- q RP Y-- -- ------�- - -- F I� Disposal Field: Distance from nearest well-...___.------Distance from foundation-------------_----.Distance to nearest lot line.._.._-..------. ❑ Number of lines i------------------ --------Length of each lire------------------------------Width of french---1M------------------------------- Type of filter material----._3-----------------Depth of filter material..-'.t....---.-.-------Total length._........'--------------------------------W • � lc I Seepage Pit: Distance to nearest well----------------------Distance from foundation...#1,,;-_-._-....Distance to nearest lot line----------------- El Nu umbel of pits :`-Lining material-----------------------size: Diamet`e t Depth Cesspool: �t ,Distance from nearest well-----------------Distance from foundation------------------..Lining material------1--------------------.- ❑ Co{ 'Size: Diameter_[---------------------------= Depth----------------------------- ------ - -------------Liquid Capacity... --------------.-........gals. Privy: "%.Distance-from nearest well----_-------------- ....Distance from nearest building-_-------- IM---------------------------- .... ❑ Distance to nearest-,]ot;,line--------------------------------- - ---------- -------------------------------------- ---------------------- ----------------------------------- -------- and/or repairing (describe)-------- :.. o— ------------L� �t _ v ------------------ ----------•---- ------------------------------------------------------------------------ --------- ----•-------•------------------•---- ----- ---- ----- ---------------------------------------------`-----------'------•-------------------------------------------•---•-------------------------- ------------------------------ I herebycertify that I have prepared this'a lication and that the work will be done in accordance Sa"i y p p pp nce with San Joaquin County ordinances, State laws, and iules aregulations of the Sa y oaquin .Lacai Health District. . - —---------- ------------- (Signed)----------------------------------------------- ---------------- ---(Owner I`nd/or Contractor) Br------------------------------------------.`� ��Q:._ ------- --- - (rtle) s II (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). ,II FOR DEPARTMENT USE ONLY �! ' i »! --- DATE---- ``3 I �r ------------- APPLICATION ACCEPTED BY - _. REVIEWED BY------------------------------- --------------------- - --- DATE------ ---------- ---------M------------------------------- ------- --- ------------------------------------------------------- BUILDING PERMIT ISSUED------------- ----------------------- - -- -- -----------------------------------. DATE---- --------------"------JM------ ---------------------- Alterations --------------------Alterations and/or recommendations---- ----------------------------- -------------------------•-------------------------------------------------• ------------------------------------------ { IM I --------------- --- --- ------------------------------------------------------------------------------•------------------------------------------- ----------------------------------------- ------------------------------- IM FINAL INSPECTION BY:...... ------------------ --- Date------------- -------- ---------------- SAN JOAQUIN LOCAL HEALTH DISTRICT ' 1601 E.Hazelton Mt.. 300 West Oak Street 124 Sycamore Street 205 West 9th Street ` Stockton,California .i Lodi,California Manteca,California Trocyi,f California ;,F.P.C 0. iL 4