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FOR OFFICE USE: -------------------=------------------'------------------ -----------____________..___..___.._.______________----- APPLICATION_ FOk SANITATION PERMIT Permit No. ------------------------------------------------- {Complete in Duplicatel --- This Permit Expires i 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 Ordinance No. 549.' ' ax JOB ADDRESS AND AT10N--------------------------- --------/� r �d ------- ,- - ---- ------- ------- -------- Owner's Name �G .. ----1--------- Address ---- �-'��_, Phone Address-----• --`�--- • ..--- �f-;'' P Contractor's Name----------•----4'P V--------------•------- ------ Phone----------------------------------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ o . Number of liven units: _�_____- Number of bedrooms __.____- Number of baths __ _____ Lot size �9 g ° 1 f Water Supply: Public system ❑ Community system ❑ Private�Depth to Water Table�.?�Jff. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay p Adobe Hardpan ❑ Previous Application Made: (If yes,date---------------------I No X-New Construction: Yes ❑ No f�J' FHA/VA: Yes ❑ NO'k TYPE OF INSTALLATION,AND SPECIFICATIONS: / 02— [No septic tank or cesspool permitted if public sewer is available within 20 eet.)- / ri Septi T nk: Distance fro'-m--nearest well ��_ Distance from foundation------I ��' f •: a erial--- ts o. of compartments-- - ---=-----------------Siie------ Liquid depth- 1 Capacity'Disl IRWd: Distance from nearest well- ___Distance from.foundation.___ --------------Distance to nearest lot line.---- Number _--Number of lines------ _._._ Len th of each line_ ��r �J _ _ �._ Width'of trench �Z _ __-_____.___ t� Type of filter mat erla5- -_Depth of filter material__- _ __-------Total length----- _--��-________ --------------- Seepage Pit: Distance to nearest well______________________Distance from foundation__-_____________.Distance to nearest lot line--------------_.. ❑ Number of pits----------------------Lining material-----------------------Size: Diameter-----------------------Depth--------------------------------- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material-------------------------------------- ❑ uid Ca acit als.Size: Diameter----- --- --- ------------------Depth-------------------�------ - ___Li q Privy: Distance from nearest welf---------------___--------------------_-._._._.-_Distance from nearest buildin g ❑ Distance to nearest fot line--------------------------------------------I.L-----------------------•---•---------------------------- Remo eling and/or repairing .-------- �t `�'ft�sC d `.,. f�t�`� t_ �� __ �( ----/�--' -----------------------------�--------- ------------------ -----------------__ ------------------r-------------------�f -----------------------------...__...._ 1-t,,,,,,FFFFFF //_ ____________________________________________--________________--__--_-_______..-__-_____-_-_-____-_____________________________.________--____..___-__._______.___-_________.___-_---_..________.______._.__-.._I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regullatioons of the San Joaquin Local Health District. (Signed) -�t/1. -------- ----------------- ---------------------- r an r--------_.-- _____ [Owne d/o CantractorJ BY - g ' - ---- {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---------------- ---------- ------------ ------------------------------------------ ATE REVIEWEDBY.------------------------------------- - ---- -------------------------------- DATE-- _----- - -- --------------- - BUILDING PERMIT ISSUED---------- ---------------------------------------------- --- - DATE-------------------------------- Alterations and/or recommendations:------------ ------- - ------------------------------------------------------------------------------•---•---- -----------------------L---------------------------------------• -------- -----------------•----- ------------------•- --------------------------------- --------------------------------- ----------- ----------------------- ------------ -- ----t----------------------------------------------------------------__'_--------------------------------------------------------------------- -------------------------- L---------- ------------------------------------ --------- - ------------- --- ----- -- ---- --------------- --- - •- -- ------------- ---------------------------- ------------------------- FINAL ------------------------ FINAL INSPECTION BY:----- --- - - Date........ -------------------------------U�.-----•------------------- - SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haxellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California ,S p Manteca,California Tracy,California 4