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F R OFFICE USE: r - ---------- --- ---�-- ----- / _�.............1-=..-•�- ----- � APPLICATION ��,F�OR;',plef4& Duplicate);SANITATIOK PERMIT Permit No. ._�.. � -------- ----- ------------ (Cor p / - � Date Issued ............................................... This Permit Expires 1 Year'.:,From 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 49. JOB ADDRESS AND LOCATIO. __ _______ / ___ ____ _____-_" Owner's Name-------------- Phone-------------------------------- zz --------- ----•------- Address---------------------- r Contractor's Name ------- �. ------ ` Phone.. Installation will serve: Residence Department House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __l___ Number of bedrooms J--- Number of baths�-Lot size ____/ ----1.91� ZOW;— __-__ Water Supply: Public system ❑ Community system ❑ Private epth to Water TaOed:' tt. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adober pan ❑ Previous Application Made: (If yes,date--------------------) No ew Construction: Yes ❑ No �IA"/VA: Yes ❑ No B__— TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Se is Tank: .. Distance from nearest well----�p Distance from foundation___________________Material----------.------------------------------------- . 4X2 Vf'o4f No. of compartments----------- - ------ ----Size--------------------------------Liquid depth---------- ---------------Capacity----------------------- pisposal Fi Distance from nearest well..-5 Distance from foundat or✓ Distance to nearest tot Number of lines------- Length of each line____ _r--------------Width of trench.__. �f___--___________ Type or` filter material-_-�Ya-- & ---Depth of" filter material__j...r-Y---_-__-Total longth__ _ _______________________________ Seepage Pit: Distance to nearest well _-If-?_-.t------Distance• m f undation___14_1_..-__ Distance to nearest lot line__.__.__f-___-- [� Number of pits-----I---------------Lining material---- c�e- _-Size: Diameter._.&_3-_//_____Deptn__ l_-�-�E Cesspool• Distance from nearest well-----------------Distance from foundation--------------------Lining material------------------------.------------ - El Size: Diameter---- - ------------ --- - ----- --- Depth----------------------------------------------------Liquid Capacity--------------------------•-gals. P Privy: Distance from nearest wel3---------------------------_-------____--------__Distance from nearest bui{&ng------------------------------------------ V1 ❑ Distance to nearest lot line---------------------------- - :- ------t-------- I-e- ------ ( 1 � �Remodeling and/or repairing Idescribe :_____.-------------- -------------------------------- -- -----------------------------------------------------------------•----- ----------------------------•-------------------------- ---------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ - ------------ ('► - D ----------------------------------------------------------------------------------------------•------------------------------------------------------------- ---------------------------------------------------------------- 1 hereby certif that 1 have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State aws and rules an ulati s of the San Joaquin Local Health District. (Signed)------ ---- �-------Sa *on'0,f6,ystem ------------------------------------------------------------------------ -----(Owner and/or Contractor) Qr By:------------------------------------ --- --------0--------------------------------(Title)----� -- (Plot plan, showing size of lot, 1 in relation to wells, buildings, etc., can be placed an reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY________ _ ----- - ---- -- -- ?" --------------------------------- - DATE--------r3__ amu^ - REVIEWEDBY----- ------------------- ------ - ------ ------- -------- -------- -------------------------------------- DATE----------------------------------------------- BUILDING PERMIT ISSUED - DATE Alterations and/or recommendations: _ __' -- ^-- a--- -- --------------------- ----------------------------------------------- -- ------------- --- ------ ------ ------------------------------------------------------------- ------------------------------------------- --------- ---------------- ------------------------------------------------------------ --------------------------------------------------------------------------------------------------------- ------- -- -------------------------- F1NAL INSPECTION BY:. - Date--------- / 1..-. ---------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Noxellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.CC.