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FOR OFFICE USE: 1/ Zj --- --- -- V Permit No. �- . `3 ------ -------- -------- APPLICATION FOR SANITATION FERMI ----- ------ -- (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 described. Thisapplication is made in compliance with County Ordinance No. 549. f. JOB ADDRESS AND LOCATION__ _ _.��- X -- r/ �1rG � ----------- Address -- Phone. Owner's Name-------- ----------- -------- Address--------- -- ---- ------------------ Phone---- Contractor's Nameivtc- /t, ----------------------•----------------------------------------------- one t� Ph Installation will serve: Residence � Apartment House ❑ rnmercial ❑ Trailer Court ❑ Motel ❑ Other ❑ A . ;'` f- --------------------------------------- NumberJ of living units. ---1-_- Number of bedrooms __.:-- Numbers f baths _ l __ Lot size ___ - Water Supply: Public system [ICommunity system [3Privatea. bepth to Water Table .9--- ft. t Character of soil to a depth of 3 feet: Sand E] Gravel ❑ Sandy loam ElClay Loam Clay [IAdobe ❑ Hardpan ❑ Previous Application Made: (If yes,date...........---.._--) No New Construction: Yes No ❑ FHA/VA: Yes ❑ Nox W TYPE OF INSTALLATION AND SPECIFICATIONS: {No septic tank-or cesspool permitted-if-public si wer is available within.200 feet.) Septi Tank: Distance from nearest well .j00-�-Distan q Material--- !lz-r? .1 No. of compartments 1 ----------- Size---F- _�--i- -- Liquid depth = Capacity Disposal Field: Distance from nearest well---t��' Distance-from foundation J is#ante to nearest�o;lin�_�_l? _____ ti '* a �� Number of {ines�._ r = Length ofa"� line �`5 `+''�'dth of trench. r- Type of fitter Ynaterial__ __�_7 Depth of filter material_.._ _--__-----Total len th__ `a--_-----------------!� �� 9 A--- �_ F -*_._Distance from foundation--------------------Distance to nearest lot line_----.._--_-_..._�� r Seepage Pit: N{utmber of pifto s--. well -�-- Lining material-----------------------Size: Diameter-----------------------Depth-..------------------------------; 1 Cesspool: Distance from nearest well____.___.-�_-_-_Distance from foundation---_---------------Lining material--..--...___--__-------_-_-.----__---.lr _� -Depth------ -------------------------- - -Liquid Capacity------------------------------ Size: 9aIs;M ❑ Diameter , -_ .�. F.� •-L---- `' ..__---Dis#ante from nearest building-------- Privy: Distance from nearest well__.__ ❑ /� : ,�I Distance to nearest lotte------------------------ •--- — �(�'��1�-c .: �] ��-�------------- ----- i -c _ I Remodeling and/or repairing (describe):f_ - '�� s 1 ----------------------------------------------------------- ------------------ - ------------------------------------------------------------ ---- -- - ------------------------------------- ------------------------------------------------ --------------------- i I hereby certify that I have prepared this application and that the work will be done in -accordance with San Joaquin Count, ordinances, St e�aws, and rules and regulations of the San Joaquin Local Health District. qq r'«" ................(Owner and/or Contractor Tale -- ------------------ ------ -- ---- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be laced on reverse side. h FOR DEPARTMENT USE ONLY •;,,: APPLICATION ACCEPTED BY---------------- � � DATE REVIEWEDBY---- - ------------------------------------------------------------ ---------------- r� y --------------- DATE--------------------------------------------------------- BUILDING PERMIT ISSUED-------------------------------------------------------- - DATE-------------------------------- �! II Alterations and/or recommendations:----- -------------- ._ ------------------------------•------------------------------- - ---------- -------------- -------------- ----------- ------------------------------------------------------------------------------------------- - i --------------------------------- -------------------- ---------------- ---------- ------ --------------------------------- FINAL INSPECTION BY----------- -- --- ---------- Date-------- ------ . 3_-7Z.4___--- SAN JOAQUIN LOCAL HEALTH DISTRICT i124 Sycamore Street 405 West 9Th Street 1601 E.Hazelton Ave. 300 West Oak Street Stockton,California Lodi,California Manteca,California Tracy,California F.P:CQ- t