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" -FOR OFFICE USE; ----- APPLICATION:APPLICATION FOS SANITATION PE ----�� l RpMIT Permit No. ------------------------ ------ --- --------------------------------------------- (Complete _---------------------- (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 Ordinance No. 549. JOB ADDRESS AND LOCATION---------%aLS------------S 0 l---- f /— ------------•-----------`---------- Owner's Name------------ G_P--1 ------------ a, ."l-&-l-----------------------------------• --- ------------------------------ --------- Phone-----..-_.-------------------------- Address----------------------------(- ( �a (00 "= _ -------------•-----------•-----------•-------••------------------ Contractor's Name : �u �----------� — -. Phone T-1-k:7g31 '/- 2-- Installation will serve: Residence �k Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ---1---- Number of bedrooms.. Number of baths _-.1__- Lot size --.75-_-_.__ Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table 6P.- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay [❑ Adobe ®' Hardpan ❑ Previous Application Made: (If yes,date....................) No X New Construction: Yes X No ❑ FHA/VA: Yes ❑ NoZ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permiffed if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well.__ Distance from foundation—---?_0----------Mate ri I----.01 .----_- ` No. of compartments-----------`�--- ----Size--JA_y_1C--``�_--------Liquid depth_------..54-?.f-------Capacity-----IF— r te t 5 Disposal Field: Distance from nearest well._..�Q__.._.Distance from foundation------5X�!-----.Distance to nearest lot line-----Ic_..___ Number of lines---.----___ 14 �� -------------------Length of each line----�®a`_�-,��--`--Width of�1trench------------- \ Type of filter maferial___ 1� �< Q -Depth of filter material---_.--I-S ''_-----.Total length-------------_-__--_-/ O_F.__.__ Seepage Pit: _� Distance to nearest well---/�0-Q----------Distance frim foundation-----�'�� Distance to nearest lot line----- __..__.._ �.:I umber of pits.-------`�--------Lining mate rial_--S', Size: Diameter:_..-t3a.`-------Depth.----_-------2-1-r!----.------ I Cesspool: Distance from nearest we1i-------------__-Distance from foundation_______----------__.Lining material_.-.-.__------._----.__..---._------. r I ❑ Size: QiameterDepth � ------------------------------------Liquid Capacity-- - ---------------------gals. i Privy: Distance from nearest well---------_------------------------------ ------Distance from nearest building-----.------------------------ --__-. y ❑ Distance to nearest lot line------ ---------------------------------------------------------------------------------------------- Remodeling and/or repairing (describe):--_.--_ --------- ----_ ?°�' ------------------- -------------------- -----------•------ - ' -•---------------------------------------------------------------------------- ------------- ----------------- ----------------------------------- 1 -•------------- =------------------------------------------------ -------------------------- -----------------------------------------------------------`------- -------------------------------- --------------------------------------_ ------------------------------------------------ I I hereby certify that I have prepared this application and'that thefork will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health Distri or- v << r [Signed}•--------------- - r i. - --------------------- - ---------------------------- ------- = -------------------------------(Owner and/or Contract By-----------------A ------ -------- (Title)- . o or --- -- ------- ------ ----------- -- of plan, showing size of lot, location o system in relation to wells, buildings, etc., can be placed on reverse side). " FOR DEPARTMENT USE ONLY :~ APPLICATION ACCEPTED BY_ --------- =------------ ---------------- ------ ------- --- ------------------- DATE------.-�--r�-=-�s------------ ------ ------- : REVIEWED BY --------------------------- ----------- ------ DATE y -------------------------------------- BUILDING PERMIT ISSUED----------------------------------- ---------------------I------------------------------------------- DATE £--------------------- Alterations and/ r recommends 'ons•---------------_ ._ = �--{- --------I- -------��'-------------- ------------------------• ------------------- ---------------••------------- ---------= ----------- - ---- __ --- -- - - -:ate -- ----- ---- -s• , :. ._ _� ... ��. c.�,.r��i`�•�: � FINAL INSPECTION BY:------- ----------- ------------ Date.-------- S SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 F.Hazellon Ave. 300 West Oak street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California