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FOR OFFICE USE: APPLICATION FOR 5ANITATION PERMIT Permit No.a-, ...................Yf____ -------------Lt (Complete in Duplicate) 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 de`sc bed. This application is made in compliance ACounfy Ordinance 549. - r 08ADDRESS AND LO TI N_____'_ -- -9L Owner's Name - ------ ----- ------------..1vAddress------------------�d ------ - - -------- -.... -` ---------------------------------------------- --------------------------------- Contractor's Name---------- -------------•---- --_ = Phone Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units-1___/_'—Num'b'er of bedrooms __,_:Number of baths ____L Lot size _s?.'a ------------------------------ Water Supply: Public system )!� Community system ❑ Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: I Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe R Hardpan ❑ Previous Application Made: {1f yes,date._.. ' NoK New Construction: Yes No ❑ FHA/VA: Yes ❑ Nog] TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted.if public sewer is.available within 200 feet.) � r Septic Tank: Distance from nearest well-----------------Distance from foundation_______ _________.Material--. _ _-_.______....__" ________._.. No. of co mpartments..._.__ -�"--_..__Size_-8._ _ �__--Liquid depth _Er______________Capacity_-_--_--_____..... 5 --Distance-to to nearest lot ling_ IV.- ------- Disposal Field: Distance from nearest well-----------------Distance from foundation__ _..__ O 7- Number of lines______"-____ -._ .__-_____ Length of each line__ 6__:`_ _.-_ Width of trench.-'Zqr----_____�_-_--.____ Type of filter--material-- -•� £Pth of filter material Total length---- --f'-U Seepage Pit: Distance to nearest well__________________ DIsta`nce i-2 four ation_____ ----------Dis�nce to nearest lot ling---5--..___._ �'t Number of pits ----------.Lining material_____/�ize: Diameter---J_.__ b pf k--c;-7.5 - Cesspool: Distance from nearest well___ _-__Distance'from_foundation------------_ _____Lining material------------------ ------------------ .,. Size: Diameter-- ----~Ar------- --------'---Depth -------- ------ - -._.---- ------ ❑: - ---Liqu;d Capacity----- -------------------gals. £"r t r PnvDistance. rom nearest well—______________ ______�_-_--__-,_..._--_.Distance from nearest building_---..__.__-"�_- y.. ------------- ❑ Distance to nearest lof line--------------------------------------------------------------------------------------------------------------------------------------------- Remode4ing and/or repairing (describe)----------------------------------- - - -------------------------------------------------------- -------------------------------------------------------- _ . I "---- --------------------------------------------------------------------------------------------------° - ------------------ ------------•---------------=--------------------- .,\ I. ------------------------------------------------------------------------------------------ ------- ---------- ----------------------------------------------------------•--------------------------------------------------------------------------------------------------------------------------------------------.-------- - 1 hereby certify that 1 have prepared thi application and that the work will be done in accordance with San Joaquin County ` ordinances, �11s, 'd rules and regul ons ofthe S n oaquin Local Heath District. __-__.____(Owner and/or Contractor) (Signed)- -------------- _ - -- -- ----- - ------- - --- ----�------ =----------- ------------------------------- iB ---------------- --------------------- -----------------------------------------------------------------(Title)------------------------- k ... (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 BY--------------- - -- --` d-' ----------------------------------------------- DATE__ -------------KI-.(K _ REVIEWED BY------ ----------"------------------------------------ -------------------------- ---- -`'---------------------------------------------- ---------------- DATE-------------------- BUILDINGPERMIT ISSUED------------------------------- = -- --- ---------------- - ---------------- DATE------------------------------------------------------------- Alt fions ---------------------------------------.Altg�afions and/or recorlmen afions------------__ -------------------------------------------------- --------------------- --------- ---------------------------oft --------- ------ -mow . r ---------------- - -------------------= ------------------------------ ------------------- ---------------------- -------------------------------------------------------------------- r FINAL INSPECTION BY: Date--- ------- -------------� ----------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 911r Street Stockton,California Lodi,California_ Manteca,California Tracy,California F.P.co.