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FOR OFFICE USE; , ------------------- -- ------ ------------------------- APPLICATION F ?R-S¢ANITATION PERMIT Permit No. z/ .. - -------------------- ---------------------- (Complete in Duplicate) 3 ----------------------------------.- 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 compliapce with County Ordinance No. 549. - JOB ADDRESS AND LOCATION._ — _- ----Fri_E(4C_H__-.61_YI__j>------RD--------01%------SAI--- -�-�? ---G� ------�A_N-F— Owner's Name----=-------/?,J?-.----._AIE0-05n----------------------------------------------------- Address---------:---------- - .--------- _0..x--------775-1----------/ jPN T-E-(-------------------------------------------------------------------- Contractor's Name------ Wify-F--�-----------------••------------------------------ -------------------------------------------------------------- Phone----------------------------------- Installation will serve: Residence JEJ' Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: I------ Number of bedroom ----- Number of baths ----- Lot size P--------------------------- Water Supply: Public system ❑ Community system ❑ Private 6�,'Depth to Water Table ft. Character of soil to a depth of 3 feet: Sand Gravel ❑ " Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ks Previous Application Made: (if yes,date____________________) No New-Construction: -Yes 93--no ❑ FHA/VA: Yes Rl"" No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic ank: Distance from nearest well-_-.10------Dista ___ Distance from foundation ____._.Mater•al__� �� T�n _____---- p No. of compartments-------a�__.-----------Size- -- -�a__ - ---Liquid depth- tl 2_)2_ ----Capacity---/Z Disposal Feld: Distance from nearest well___ _��___._Distance from foundation_1Q----------Distance to nearest lot line--- ---___ Number of lines--------- ------Length of each line_75�_$_76._._.Width of trench_._.__._. .__ _. r--------- Type of filter material � _ __flO� ____Depth of filter material_______ _ _".__._Total length---------- Seepage Pit: Distance to nearest well------------------_---Distance from foundation--------------------Distance to nearest lot line.____...________ ❑ Number of pits.--.----------------Lining material-----------------------Size: Diameter-----------------------Depth___-------------------------- Cesspool: Distance from nearest well-----------------Distance from foundation-----------------...Lining material-._____- _._________.____________._. ❑ Size: Diameter--------------------------------------De Depth ---------------------- - --- ----- ---------Li Liquid Capacity ----- gals.p q p Y - --- - --- Privy: Distance from nearest well----------------------------_---------------------Distance from nearest building-____.___.._____.____._____________..____- ❑ Distance to nearest lot line------ ---------------------------------------------------------------- -------------------------------------------------------------------- Remodeling and/or repairing (describe):- - ----- --------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------ --------------------------------------------------------------- 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. ----- ----------(Owner-and/or_Contract BY:----------------------------------------------------------------------------------------- -----------------------------------------(Tit le)----------- ---- -------------- ------------ .. .. - (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---- ------f-R_Q__- ------------ - ----- ---------------------------------------- DATE------ ------------------ - - REVIEWED BY------------------------------------------- ---- ---- DATE----- -------- ----- BUILDING PERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE------------------------------------------------------------ Alterations and/or recommendations--- ------- -- ------ ------------- ---------------------------------------------------- ----------------------------------------------------------------- to�FINAL INSP TION B 4 .... Date_..---------�(1. p ' ,! SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Mantecar California Tracy,California F.P.Cd. a