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- - - vu `2-7..16s_----------------/6---3_0---- /J � APPLICATION FOW�.SANITATION PERMIT Permit No. .._1....5>___ -- -------- V (Complete in Duplicate) ------------ --- ---- This Permit Ex Expires 1 Year From Date Issued Date Issued --__- 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. 1 JOB ADDRESS AND LOCATION_-----��: �� / ----------------------------------------- Owner's Name----------------6V1_r1 i� --..----------•y e-1aS ---------- -- = >�GS�Cs! -- Phone-/ Address--------------------- ------------------------------------- --•---- ------------------------------------------------------ ------- Contractor's Name ------------------------------------------------------------------------------------ Phone-----------------------•----------- 1. Installation will serve: Residence partment House 0 ; Commercial [-,, Trailer Court E] Motel E] Other F] Number of living units: ---I--- Number of bedrooms -- Numbe' r'-oftibaths J---- Lot size ----_!�O_XJ_ ______________________.____-_ Water Supply: Public system ❑ Community system 2- Private E] Depth to Wafer Table _<�p ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑-' Sandy Loam ❑ Clay Loam 0 Clay ❑ Adobe ardpan ❑ Previous Application Made: (If yes,date--------------------) No New Construction: Yes ❑ No [ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: I m (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tanj: bi'stance from nearest well__1 ? Distance,f`rSoimoun `a .on_1C - Mae ria__ } «�__._________ (No..6f compartmens---------z--------— Size .' ;--Liquid depthy -------------Capacity._Jr4 disposal Field: f 'Distance from nearest�Well-----.--`.._._._DistanceYPfro foundation^ Tk_.:_Distance to nearest lot line----------------- ❑' Number of lines__----J-_ _ =-------------------Length of each line-_----------------`----_------Width of trench---------------:------•------------ 6 Type of filter material-----------,= "°--------Depth of filter material-------jF._.s.Total length_______ ______________________________ Seepage Pit: Distance to nearest,well_ �&. ----I--------Distance from foundation--------__`.- .__"-_Distance to nearest lot line----------------- ❑ Number of pits---:�-_-___-----_"_Lining material__---____- --- Diameter__.....................Depth-.-----------_-__.-._-.-__._._._. Cesspool: Distance from nearest well--------------_Distance from foundstion----------- --------Lining material_.-.-____._------------------------. ❑ Size: Diameter_ ., -__ Depth :Liqud Capacity........ -------- gals. ______________.Privy: Distance from nearest well-------_-----_-----------------------------------Distance from nearest building_--.-.---_-----_--.. ❑ Distance to nearest line.---------------------------------- ) Remodeling and/or repairing (describe);------------------- ------------- -------------- -------------------------••----------------------------------------------------------••-- ----- ----------- ------------------------------------•-------------------------•------------ ---•-------------------------------------------------- •- -----------------------------------------------------------'------r--------...------- J, -----------==-`----------------------------------------------------_---------------------•------------------------------------ --- t _ --------------------------------------------------------------------------------------------- ------------------------------- 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 andegulations of the SanLJoaquin Local Health District. (Signed)-- -----------Ef ----------------------------------------------------- {Owner and/or Contractor) . r ------. By:------------------------ -•--------------------• '----------------- ------------------ -------------------------------------------(Title)--------- ----------------------------- - - - -- -------------- (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 f APPLICATION ACCEPTED BY ` ---------------------- DATE � ,�"a REVIEWED BY --- DATE BUILDINGPERMIT ISSUED--------------------- ------------ ---------------------------------------------I-- -- ------------- DATE---------------- -------------------- Alterations ant!/or recommendations:----- ------" - = 9 —i ---------' ----------------------------- ---------------------•-- - - - ----------------- ---------------------- ,� FINAL INSPECTION BY:. - ---------/�-4-_----(i/ _ Date...... --------- - f 1 SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lad!,California Manteca,California Tracy,California ya:.