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FOR OFFICE USE: - ------------ APPLICATION F C7 OR SANITATION PERMIT Permit No. -.-.!__-•--•------1-. (Complete in Duplicate) / _ ___ -- ------------------- 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. /�� iiC° JOB ADDRESS AND LOC ION------------- -- ---------1�_.------- L -,e - ------- ----- yOwner's Name.-------------- ------------------------------ -------------- Address-..... ------------ ` Contractor's Name----------- ' %Sfi L f''C--------------------- ---- --------------- Phone---'•�--�--- ��D.� Installation will serve: Residence 0 Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ ; (rt Number of living units: ---1-__ Number of bedrooms _- 9 Number of baths .- __-- Lot size __-_-- -fJ--X---,S --------------------------•- Water Supply: Public system [Community system ❑ Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam E5-1'lay ❑ Adobe ❑ Hardpan ❑ i Previous Application Made: (If yes,date.----------,_--------) No New Construction: Yes ❑ 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 Ta k: Distance from nearest well----_-_-------Distance from foundatidn_--�D------__.Material_._.!-k��.�� 6X41Pk_,S___Liquid depth--- �� No. of compartments-------- --_--..--Size_-- ------Capacity.;! - � Disposal Field: Distance from nearest well........ --------Distance from feundati n___ r0--�-..Distance to nearest lot line___3_.----__ ---Length of each line "s ,> Number of lines - -- ----------- - g _!-T.Width of trench--- -------------------- Type of filter material---'Aiko_1 Depth of filter material__! ''______-Total length......rh__ ---------------_ Seepag Pit: Distance io nearest well--------s-------Distancef om foundation------�4---------Distance to nearest lot line..EK . Number of pits-------------/-------Lining material---A&Ir __...Size: Diameter----�3___-__.-----Depth.......---____._____-_ Cesspool: Distance from. nearest well-----------------Distance from foundation-- ------____.._..Lining material------------------------------__---_-. •.jj ElSize: Diameter---------------------- --------Depth-----------------------•------------------------ ---Liquid Capacity----------- -------------- -gals. C► r Privy: Distance from nearest well.------------------ -----------------------------Distance from nearest building------------------------------------------ ElDistance to nearest lot line------ ---------------- --------------- ------------------------ ------ ------- ---------------------------------------------------- Remodeling and/or repairing es ibe�: ----•-- .�'�5�• -,-I ------- +1 --------------------------------- -------------- -------------------------------- ----------------• ��`-----&,1 / -�--------------------------------- ---------------------/ ------------------------------------- ---------------------- ----- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County 9 ordinances, State laws es and regulations of the San Joaquin Local Health District. (Signed) G------------------------------------------ - r and/or Contractor) --------------------------- By:------------------------ -------- ----- ----------- -------------------------- (Title) ------ ----..------ (Plot plan, showing size of lot, location of s tem in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---- --- - �-- --------------------- - ---- -- ----------- - -- -- ----------------- DATE-- �^�h�`4�------------------- ----- REVIEWEDBY-------------------------------- ------------------------------------------------------- ----------------------------------- DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED------------- -------------------------- ------------------------------------------------------------- DATE--------- --------------------------------------------------- Alterations and/or recomm nd tions• -------- ---------------------- w --- ----------------------------------- - - --------- ------------------------ - --------------------------- ---------- --------------------------------------------- I --- ----- Date_ 1' /_ �.... FINAL INSPECTION BY:----- - �t.��.."�------------------ -------------- ----- -- - ----------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT i 1601 E.Hazelton Ara. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.00.