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�Ut� , fICE USE: _f -- - `. APPLICATION FOR SA-NI -- TATION PERMIT Permit No. ....r----------------- �- (Complete in_Duplicafe) A lication is hereYear From Date Issued i Date ssue Pp b madeiThis Permit Exp fires 1 y ',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. II - JOB ADDRESS AND L C`- TION___ Owner's Name-------- on I -- -- Address-----... wow [r, i --=-------------------_----------------------------------------------------------- ... Contractor's Name....... - ..._ - - -- - - ------------- Phone ---- Number se livin units -- ____. { ------------ Installation will serve• Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel - qq ` ❑ Other g_ : .-/___ Number of bedrooms _Pd__ Number of baths -_f-- Lot size 4P'Q� ------------ ------------------ ------•--- ----- ----------- Water Supply: Public system �ommunity system E] Private F1Depth to Wafer Table "f+ is t Character of soil to a depfh:':of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑.. Adobe 2--lH"ardpan ❑ Previous Application Made: Ilf yes,date___________ ________a . 'No ' ai [�—"New Construction: Yes �Vo ❑ FHA/VA: Yes-g�—No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No sep"tic fank or ce"spool permitted if public sewer is available within 200 feet.) Septic Tank:,;;'. 21fMIOPItments nearest well __-°•'�"-'--Distan e �n foundation___ __,g,/ fl✓ --.__.MateL7 No. of _-_-_�-------- -----Size_ ✓rr�� Liquid depth- �---__----Capacity_ --is onc Number from nearest well.___.^"""----Distance from foundation _ __.._ ___ P e ��___.Distance to nearest lot line_+�_ --___ W Disposal ie Distance of lines___. _ _Length of each line_'� ,�_�---___---.Width of trench ______..___. _ Type of filter materia .Depth of filter material_ --- - --- Total length____RO ------------- Seepage Pit: Distance to nearest well----- --------Distance fEwn fou dation_o,9P."_.Disfan�to nearest lot line__-�_.. ' Number of pits________ ___________Lining material Size:'Dlameter-.,� ------.Depth___112, x� Cesspool: Distance'from nearest well------------- _Distance from foundation--- ________f------Lining material--=---------- ----------------------- ❑ , at Size: Diameter - -------- Depth------------- Liquid Capacity gals. Ci 1 Privy: Disfance:'from nearest well:__.__________-- ______._..-Distance from nearest buildin ❑ Distance to nearest lot line---------------------------------c--------------------------- Remodeling and/or repairing1i(describe):----- A� J .I . --- -------------------------------------------------- --------------------------------------------- 4I - - ---------------------- , _ ii --------------- ------------------------------- ---------------------------------------------------------------------------------------------------------- --- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances. State lawsandr le and regulations of the San Joaquin Local Health District. 2 --- a� ._r` (Signed) ---------------------------------------- II r Contractor) Sy:------------------ t o or ---------•-------•------------------------ =' - --(Pll at plan, showing size of lot,';Iocation of system in relaf to wells, buildings, etc., can be placed on reverse side). :.i FOR DEPARTMENT USE ONLY �- APPLICATION ACCEPTEQ Y DAT_ _ ��REVIEWED BY _ - I .___-___________________ E----- ----- a - -- DATE---•----- - --- - --------- --------- - ---- ------------------------------ ----- -------------------------------------------------- BUILQING PERMIT�ISSUED------------------------------ -------- -= ----------------------- - DA`•TE-------------- Alterations and/or recommendations:-------------=- -"---- --------- --- - -(----—- ---:-------- - f - --------------- ------ ----------------------- --------- --------------------------------- ____________________.._--_-..__.___...._..__.__._...______ ---------------- FINAL INSPECTION BY: T Date ------------------------------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Harellon Avo. l 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California I� Lodi,California Manteca,California Tracy,California a E6 9 REVISED 8-59 3M :3-'63 F.P.CO. �I