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t FOR OFFICE USE: APPLICATION FOi 5ANITATION PERMIT Permit No. .1 . . .� _ k-` „ -r ' (Comple�fe to l6licate) ._ -----------------=------- -- -- - ---------- I This Der mit.Expires', ear From Date Issued .'Date-' Issued Application is hereby made to the San Joaquin Local Health•iDistrict for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance,No..549. JOB ADDRESS AND LOCATION.------7 P--___ --' + Owner's Name------ ,�- Phone Address /-aQ_..__ 1` --- Contractor's Name-_', -------------------------•---------------- --------------------------•- • ----- ----- Phone----------------------------------- Installation will serve- Residence ❑ Apartment House commercial Trailer Court ❑ Motel ❑ Other ❑ 6 f Number of livin'g units: _ __ Number of bedrooms Number of baths - _ Lot size __s.�C ----------------------_____________ Water Supply: Public system Community system ❑ Private ❑ Depth to Water Tablef Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: (If yes,date_______________,____) No K New Construction: Yes ❑ No � FHA/VA: Yes ❑ No [;_ .. TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ASevc Tank;, Distance-from nearest well-----------------Distance from foundation------------- ------Material---------------.-----_-.-_______________._..__- � � No. of compartments- ----------------------Size----------------=-------------Liquid depth_.-------------- ---------Capacity- -------------- Disposal, Field: Distance from nearest well------------------Distance from foundatitin--------------------Distance to nearest lot line_________________ `� Number of lines____________.._. . Length of each line_______.__C.-�" -___ _..Width of trench_____ - ''-________________ + Type of filter material-------------------------Depth of filfier material__ �Total length--------!�F._________ ___.._--_-__._ p 9 �6+� Distance to nearest lot line-��___~`_ I See a e Pit: Distance to nearest well___''-"-'.____Distance from foundation__ __ _________ [ _ - f [�" Number of pits-----/___...__.___Lining material_ g'�.__.Size: Diameter_---47 -----.-Depth__�� ' Cesspool: Distance`from nearest well_.__`___.___._-Distance from foundation----------------___Lining.material____.-__.._....____._ ._ ?4 - ------------ ❑ *-Size:-Diameter------------------------------+------Depth--------------------- ------ ---------------------Liquid Capacity----------------------------galls. Privy: Distance from nearest well----- ----------------------------------Distance from nearest building-___-_-..__________________________..._ ❑ Distance"to nearest lot line._ ----------------------- -------------------------I------------------------------------------------ ------------------- 4 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. {Si ned 9 } ------ - -- - � - ---{�r Contractor) By: - {Title) ---- ----------------- (Plot plan, showing size of lot, location of system in re on to wells, buildings, etc., can be placed on reverse side). " FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED 13Y----- -"----------------------=--------=----------- '"=. REVIEWED BY --.----- - -' 11- -- DATE----- ----- _5------------------ ------- --------------------------------�-----------`----- ---------------I -------- DATE-- BUILDING PERMIT ISSUED-------l--------:-- _ ----------------------- ----------- - -------- ,• DATE---- --.-. -- -- c - -� -- ------Alterations and/or recommend atons --------------- -------------- --------a '-J --� _ ----------.-�w�� -- --- t / l �.� lr-- ----------- --------- FINAL INSPECTION BY:._�. --- ----- Dater------- -1.- T - --------------------------------------- .. -SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F. CP O.