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F FOR OFFICE USE: a �� APPLICATION AOR SANITATION PERMIT Permit No. .l�`�lP_..I-. ---------------------------------------------- ---------- (Complete in Duplicate) . - �-�-..� -- This Permit Expires 1 Year From Date Issued Date Issued !5- 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 7 s? ------------ -----------------------------------------------------------------•---------------------------------------- Owner's Name---------------------- e,<_r--•---- 'fir --------------------------------- Phone-. Address-------------------------------- 40 -----------W�------- ---------:5"7-7,--.- --------------------------------------------------------------------------- Contractor's Name lQ i / .S/f✓ A ---------- --- Phone_l��._-? ------ Installation will serve: Residence Apartment House [] Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -_Z-- Number of bedrooms _- -- Number of baths .. _ Lot size ----- -- a--.------. -- - --------------- Water Supply: Public system [Community system ❑ Private ❑ Depth to Water Table -------- ft. 1. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam El-'Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date----.------ -) No a- New Construction: Yes [5^o 2�HA/VA: Yes ❑ No [}� TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well-------------Distance from foundation----+---------------Material---------------------------------------..-.-----. ❑ No. of compartments--------------------------Size----------------------------:---Liquid depth--------------_------.--Capacity-------------- -------- Disposal Field: Distance from nearest well-----------------Distance from foundation-------------------.Distance to nearest lot line--------.---..-.. ❑ Number of lines-----------------------------------Length of each line------------------------------Width of trench--------------_-------..-..--------- Type of filter material-------------------------Depth of filter material-----------------------Total length-------.--------------------------------.- , Seepage s : Distance to nearest well----------------------Distance.fr foundation---.. -�rDistance to nearest lot line----r [ / � Number of pits--------1-----------Lining material-_ el&!Ve----Size: Diameter... -------------Depth--.- ---------.- w ^� E Cesspool: Distance from nearest well-----------------Distance frorri'foundation-_-----------------Lining material____.--------------.------.---------------------- 0 Size:Size: Diameter---_-----------_ - ------------Depth---- ---- ----- -------- - ---_--------.-.Li Liquid Capacity ----------------- Privy: .-g- Distance from nearest well-------------------------------------------_---Distance from nearest building_______--__.-.-------.--------------.--.-. ❑ Distance to nearest lot line�--------------------------- ----- ------------ ----------------------------------------------------------------------------------------------- Remodeling and/or repairing (describe):-- ------L.:-L.� -.-----4t{------ -- - ----------•--------------- ' --------------•--------------------------------------------------------------------------------------------------------- ------------ -------------------- --------------------------------------------------- ------------------------------------------------------------------ ----------------------------------------------_ --------------x--------------------------------------------------------------------------------- ---- ---------` - -- '--'-"-' ----------------------------------------------------------- ' " ... ------------------- -------------------------•--------------------•-------------------•----..--..-..--------------`------------' - - - 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, ules and regulations of the San Joaquin Local Health District. i (Signed)----------------------- / / l ---------------------------- ----------- ---- ------------------ wn nd/or Contractor) ------------ = (Title)-- By: ................... (Plot plan, showing size of lot, locati of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -- - ---- --------- DATE_3_--?_-&6'_.------------------------ ---- REVIEWE -- REVIEWEDBY-------------------------------------- ---- ------------------- ------:`-----------t--------------------------------------- DATE----------------------------------------------------•------- BUILDINGPERMIT ISSUED-------------- -------------------------------------------- DATE------------------------------------------------------------ Alterations and/or recommendations: . / .... -3- s =--------------------------------•-•------------•-----------------•---------------------------- - ------------ ----------------------------------------------------------------------- ---------------------------------------------------------------- -------------------------------------------- ---------•-------------------------- ------------------- -------------------------------------------------------------------------------------------------------------- ----------------------------- ------- --- - ---------------------------------------------- ------------ • -------------------------------- - FINAL INSPECTION BY:.- C. = Date...... � ------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.0 6.