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FOR OFFICE USE: 02 ---------- -- ---------- ----------------------------- APPLICATION W.R4SNITATION PERMIT Permit No. .�1 l - (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. iJOB ADDRESS AND LOCATION.__ ..._."S.. ------------ ---- -- Via _/-- ----------------------�----- ---------- ----------------------- ------------------- Owner.s ----------- - Owner's Name ---- Y 09 _ _ �----------------------p=#� ---------- Phone--- - Address - ----- = ='! G --------------------------------------------------- ------ - I i Contractor's Name------ ----=-5 ---- ---•--- ------ ---------- --- Phone----'--. ••-----------• C/1, . ' Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ 1 Number of living units: _.f_-_ Number of bedrooms ________ Number of baths __-j_"Lot size __-__ _./_____._e4rZ- ------------------ 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 ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: (If yes,date_. - ] No ZNew Construction: Yes ❑ No �N'A/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted`if public sewer is available within 244 feet.) _Distance from foundation_.-_ --- CMS' ! Septic Tank: Distance from nearest well_____-_--._ �--�-�____.Material e_______________ ____________tom t EEjXr s/-'f No. of compartments---------;2 - --.-Size---------- - Liquid depth------ -- ----- - --------capacity------------------•---- �� Disposal Field: Distance from nearest well...$-_._.._Distance from foundation__Y_P_.__-.-_Distance to nearest lot line___-_____-_----- ---___-__________Length-of each line_�3�_�_ _ _._.Width of trench--__ ._ Number of lines..-.----------- '--------------- r Type of filter material....S_.r/POO�__Depth of filter material----1_q_..._---.-..Total length----- _.a____________________---.__-.- Seepage Pit: Distance to nearest ___--Distance from foundation---yO-------Distance to nearest lot li e-_.`. P______ ` Number of pits... ..._/ Lining materiaI__/T°"_C_e_--- Size: Diameter----3-3----------- Depth....�2_� _________________ Cesspool: Distance from nearest well ________________Distance from foundation_.........___. ..Lining material-_.-__________---------._._____�:_- I' ❑ Size: Diameter. -- -------- ----- ----------------De Depth------ Privy: Liquid Capacity. -_gals. P :------- ---- 9 P y. • ---------------- Privy: Distance from nearest well_____-. ---_-------------- --------------------Distance from nearest building_.----------__._.___-_______----._____-.. ❑ Distance to nearest lot line ---- --- ----------------------- ------------------------------------- --------------------------------------- --•------------------- Remodeling --------------Remodeling and/or repairing (descr;be)!--------- ----------------------- ---------------------------------------------------------------- ------ ¢ ----------------------------------------------------- ------------------------------------------------------------------------------•-------- -------- ------------------------------------------- ---------- ---- ------------ - ------------------ -----------------------------•----------------------•----------•------------------------------------------------------------------------------------------------------ I hereby certify that I have prepared this application and.that the work will be done in accordance with San Joaquin County l ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed) %�<_ � — -------------------------- --_----------------------- - -----02=9-a I By-------------- ------------- ---------------- ------------------ ---------- --- ------ ----- -----(Title)------------- - L-------- --- - ----------------------------- (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 ----- -- -- ----- ----------------------- DATE_.... T a Y_0------�1:-------------------- REVIEWEDBY-----------------a---------------------- -- ---- ------------------------------------------------------- ----------------- DATE-------------------•-------------------------------------- BUILDINGPERMIT ISSUED-------- -- ------------------------------ - •- ------------ _ /DATE------------------------------------ - --�-- - --------- Alterati ns a d/or recommendations: ---- ------'� ---- ----------- 6 _r--r-�``�-'�- - ---------------- -`/ -----�':------- -' --r----------- _.--••----='F-'`+1------- .- ,. $`_ i ------------.-------------------------------------------- ----- --------------------.-...- .. FINALINSPECTION BY:..,.-.------------ - ---- -------------------------- ----------- Date------. ------- -------------------- ----- -------------------------.----------- I SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Slotkton, Lodi; California Mantetar California Tracy,California Califorrii6'"'"`M , E.H.9 2M 1.67 Vanguard Press s