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FOR OFFICE USE: •f" �-��--------- ---- --- ------ .. APPLICATIO .SANITATION PERMIT Permit No. .�,1�.G'��.-•--- __ (Complete in Duplicate) ---------------- - ------ N �Rw ------- - ------- F - - .Date Issued . .- - This Permit Expires 1 Year From Date Issued I - -------------------------------------- -- ----------- - Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein desert e . This application is made in compliance-with County Ordinance No. 549. JOB ADDRESS AND LOCATIONw__________---�-3-- •---------- ---- ---------------------- f /' Phone------------------------------------ Owner's Name G ---------------------------- 3s'------ ---- --------------------------------- -- -------------------------................ Address. = --•--- - ---- -------------------------------- - Phone------------------------------- �Contractor's Nam - I. Installation will serve: Residence Apartment House ❑ Commercial'❑ Trailer Court ❑ Motel'❑ Other ❑ -•--------------- Number of living units: -A--_ Number of bedrooms __ - Number-of baths r------ Lot size --.------ _./ Water Supply: Public system ElCommunity system F-1Private [Depth to Water Table - ft. Character of soil to a depth of 3 feet: Sand E] Gravel [I Sandy Loam ❑ Clay Loam El Clay E] Adobe �rdpan (I { Previous Application Made: (If yes,date--- ------- --- ----) No RT�_ New Construction: Yes [No ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available wi+hin 200 fee+.) 1 ' /a Material -------- Septic T nk: Distance from nearest welLtd------__-Distance from foundation- --- o f ---------Size----- x6 'rte ---Liquid depth---_/--- ---------- ---Capacity D _o, No. of compartments-.._�i-____.- - 1 � - , � w Disposal Field: Distance from nearest well:,a___.._Distance from lfoundation._1A!---_---.-_Distance to nearest/l�ot line-`sL------. Number of lines-- ------ ---------------------- Length of each line- 'Q__�------ ----------- Width of trench----a/ ___.._____.- ------ R. Type of filter material"_�.�.b-C,-�C..---------Depth of filter material_"--/$---------------Total 4ength;----g4____---------------------------- 9 Seepage Pit: Distance to nearest well--deo.............Distance from foundation-J9------------Distance to nearest lot line- ----.--- Number of pits---i------------- Lining material -- -� -Size: Diameter-- Y. -----Depth-- e4�----------- Cesspool: Distance from nearest well-----------------Distance from foundation_-------------------Lining material -.-.__------------------- els- --------- . ❑ Size: Diameter------------------------------------- Depth--------------- ------------------------------------Liquid Capacity_------------- --- - ----9 ---- -- _ _ ---------------------------------" .Distance from nearest building------------------------------------- Privy: Distance from nearest well �. . k ❑ Distance to nearest lot line----------------------�------ - - --- ------------------------------ ------- -------------------------------- ------- -------------------- ------------------ b ---------------------------------- 1 Remodeling and/or repairing (describe):----------.-?---------:------------------------------------------ -------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, LS+ate laws, and ule and r gulations of the San Joaquin Local Health District. (Signed)------ ----------- ------- - ----------- -------- ----------------------------------- ------------------------- --------------------------------. - Ow.neG or Contractor) Tltle ` -------------- --- -. BY- -- - ----- - - ( � .) (Plot plan, showing size of lot, location of system in relation +a wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY t APPLICATION ACCEPTED BY=------r- "- DATE -rf�� - - ------=------------ ----------- --------------• DATE---- '-------------•---------------------------------------- REVIEWEDBY----- ------------------------------------ ------------------------ ------------------------------ ATE I BUILDING PERMIT ISSUED------- ---------- - ------ Alterations and/or recommendations; O ra -~ G` "--- ---------- --- ---------------------------- ---------------------- ------------- -------- -- --------------------------- ----- FINAL INSPECTION BY:" __�- _��-- Date---- G ------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haselton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.0 o.