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° G ----- - .�. ._..__.__--- -------------------------------- APPLICATIONFOir, SANITATION PERMIT Permit No. ----- ------------ -------------------------- -(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 dinnstall_ he wo her ' ' scrib d. This application is made in complianwith Coun Ordinance No. 549, tw JOB ADDRESS LOCA I N_ t f 1 Agitj -- - ----------- Owner's Name_- -�__.-t:- .F- �1 --------------- Phone__...�I Qg_.M Address-'n •�/�So. , �-,� Contractor's Name-- --- •-- ,Q _. 4�T------13tt�s----------- ----------------- Phone:e./_44t- Installation will serve: Residence partment House ❑ Commercial ❑ Trailer Court E❑ Motel ❑ Other ❑ 191-31'0-&r, Number of living units: __1____ Number of bedrooms ' Number of baths2X____ Lot size .-._---._ Water Supply: Public system ❑ Community system ❑ Privateepth to Water Table ft. Character of soil to a depth of 3 feet: Sand Gravel Sand Loam k-10cla Loam 'Clay Adobe Hardpan P ❑ ❑ Y l� Y ❑ ❑ ❑ ❑•: Previous Application Made: (If yes,date--------------------) No ❑ New Construction. Yes ❑ No&K01FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) C1' O is Ta ':1 Distance from nearest well_________________Distance from foundation--------------------Material ____._..-._____. N . of compartments--------------------------Size-------------------------------Liquid depth----------- --------. Capacity... �' 11 sat fid: Distance from nearest well_1�Q.__--Distance from foundation---/10----------Distance to nearest lot line ._-: �- i Number of lines----�_...��y Length of each line,.,5�----__.----.__.Width of trench, .------------------ SO - ---.-._._---___- �� Type of filter materia SO -��_Depth of filter material___--/_ -----.Total length---------------- p_------------ Seepage Pit: Distance to nearest well--------------------_Distance from foundation-------------f....Distance to nearest lot line----------------- '0 ❑ Number of pits-------------- --- ---Lining material---------- --`---------Size: Diameter-----------------------Depth--------------------------------- Cesspool: ---------------•- -Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material--- fo ❑ Size: Diameter -------- --------Depth-------------f-------------------- ------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest-well-------------------------------------------------Distance.from.nearest buildin �► ❑ Distance to nearest lot line----------- ---- -------------------------------•-_-------__--•- Remodeling and/or rep ' ing (des ' e)----------------i- - -------------- -------- - ---------------- ------------- ----- --------------------------------- -------------- ------------------------------------------- -------------------- -- --------------- -- -- - ------------------------- ------------------------------- -- ----------------------- •--- - ---------- ---- --- ---------- ----- --- 4j------------- I hereby certif t l have pared this a I' tion and that the work ill done in cordance with San Joaquin County ordinances, S e rues a gulations of A Sa Joaquin Local a t D' trict (Signed)----------------------------------- !/ -- --- (- -- -- ------ - - orContratt r) By:---_-------------------- -- -----•-•------------------------------- - (Plot plan,.showing size of lot, location of system in relation t ells, buil ings, a ., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-----------..---------------------- ---- 5. ----__-- - -------------- DATE---- -----•-- --- �� REVIEWEDBY ------------------------------------ ----------- ----------------------------------------- ------ ,DATE------------------------------------------------------------ BUILDING PERMIT ISSUED ------------------------- --•--- DATE.----------------------- ------------------------------ A terations and/or recommendations:---------------------------------------------- -----------•----- --------------------- -----------------------------------•---•---.-. ------------------------------------------ --------------------- FINAL INSPECTION BY:.....................__& ...... --•-.------- ------ Date-------------- SAN -- -------=-SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Harelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 AEVISEG 6.59 3M 3-'63 F.P.CC. 'N