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FOR OFFICE USE: j APPLICATION EOR SANITATION PERMIT Permit No. .... _ � - ------------- (Complete-in Duplicate) This Permit Expires 1 Year From Date Issued Date Issued .l __� _ � 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 ANDIOCATION---' Owner's Name---------- -----------------------------------t 'Phone --�rF--- Address--------------- � �� Contractor's Name------ lr0 �'[,-------- to-�-s { , Prone/s.? -=-�We4d ' Installation will serve: Residence VApartment House ❑ Commercial ❑ Trailer Court [] Motel ❑ Other ❑ Number of living units: _/__ Number of bedrooms _.2-_ Number of baths __/._ Lot size ----- �2. _ A _ Water Supply: Public system ElCommunity syste ElPrivate epth-to Water Tablef�_ ft Character of soil to a depth of 3 feet- Sand V Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date-- --------- ----- J No 2---New Construction: Yes ❑ No 9?--_FHA/VA: Yes ❑ No ®_ , TYPE..OF INSTALLATION AND SPECIFICATIONS: - „•tel_ �__ _ ,•.� _. _ . � _ opt se 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 compartments-- ---- ---- -- -----Size-------------=------ -----------Liquid depth------ --- --------Capacity----- ------------- Disposal F' d: Distance from nearest well ��_ ..Distance from foundation____-/10._F__-_.Distance to nearest lot line----- Number of lines __.____---- - Length of each fine_____________Ze_d-__-_-_.Width of trench .-__-�_�_"_-_____-_-_ T-------- r, Q r Type of filter material._./_�� -Depth of filter material----- length__--__.___4__-_______________________ Seepage Pit: Distance to nearest well--------_______------ Distance from foundation--------------------Distance to nearest lot line--.---- El ine__.---❑ Number of pits--- --------- ---- Lining material---------------------- Size: Diameter----------------------Depth-.-...---- -------------------_-- Cesspool: Distance from nearest well _____________Distance from foundation.-_-----------_- -Lining material__-__-_.__----_--_--___-___-________. l ❑. Size: Diameter- -- --------- ----- ----------------Depth-- ------ -__ -----------------------------------Liquid Capacity-.--------------------------gals. ! r .r. ' - Priv Distance from nearest well -_.____._.______________________--"'Distance frnm nearest�buildin ❑ Distance to nearest lot line . ------------ -----=----------------------------- i Remodeling and/or repairing (describe: ' Y . _ ----------------------------------------------------------- ------- ------------------ --•--•-•--------------------------- ---------------=---------- -------------------------------------------------------------------------------------------- -------------•--------------- ----------------------------------......------------ -----•--------------------------------•----------------------- � ---------------------------------------------------------------------------------------------------------------------------------------------------- -- -- ------ 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, and rules and regulations of the San Joaquin Local Health District. (Signed),- f ---- ------------------•----- --------------------- --- -- -(Owner and/or Contractor) Y• = ' --- - ---------------------- -------------- ------------- ----------I I itlee)................. _ �,,---_,��.� (Plot plan, showing size of lot, loc ion of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY ) APPLICATION ACCEPTED BY. . -'V' X&---------- - ---- -------------- DATE_�.Z �--�- G Z REVIEWEDBY----- ------------------------------- -- -------------------------------------------------------------------------------- DATE------------------ I BUILDING PERMIT ISSUED-------- ------ - ------------- DATE--------- --------- Alterations and/or re om edati ins: �_ 14�v` �L. ------------------------ �-'N-.^rh.-4-----------------------------------------------------------------------_------------------------------ - - FINAL INSPECTION BY:------ /6�L----- ------ Date------SAIN LOCAL HEALTH DISTRICT 1601 E.Hazellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street { Stockton,California Lodi, California Manteca,California Tracy,California E.H.9 2M 1-67 Vanguard Press -' 01 l