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FOR OFFICE USE: -------------- 44 ------------_6 iAPPLICATION FOk SANITATION PERMIT Is P.errplt No. --------------------------- ---------------------------- (Complete in Duplicate) ------------------------- This Permit Expires 1 Year From Date Issued Date Issued __:/ _;,<<5 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. JOB ADDRESS AND LOCATION___--1-p 6---`1------ Owner's Name.--- _------ -_-- Address - --------------------------------------- ------------------------------------------•- Contractor's Name--------- '-'�Z--------- --------------------•-----------•-----------••-----------------••---. Phone.. H..`z----------------------- Installation --=3 --•- Installation will serve: Residence a Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: /.---- Number of bedrooms ,__-. Number of baths -1____ Lot size -------J74------ ___- _____________ Water Supply: Public system Ef Community system ❑ Private ❑ Depth to Water Table -------- ft. 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 E New Construction: Yes ❑ No a FHA/VA: Yes ❑ No Ej— TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well_________________Distance from foundation--------------------Material-.__.__--.-_____-__-_____---___.____.___________- C�1 "-«3" No. of compartments---------------------- ---Size--------------------------------Liquid depth--------------------------Capacity----------------------- Disposal Field: Distance from nearest well___AVO--_..._Distance from foundation____ c_.__...__.Distance to nearest lot line-_3----------- Number -- -___Number of lines--------/------------------------Length of each line-------,3s>----------------Width of trench___------ j_._.._.____-•-- Type of filter material___-_ Depth of filter material-----1_X----`--_.__Total length------ 4__'_> ----- ----------------- �___ > Seepa 'Pit: p Distance to nearest welL___IVs�----------Distance from foundation----/_-F..-......D. nearest o " Number of pits_________ ______ __Lining materiaL__1�'.e-5.I------Size: Diameter__.. _ Depth..___4__-_____ -------------- VP -- Cesspool: Distance from nearest well____.______.---Distance from foundation-------------------- matenal _________.___________._ Ilk ❑ Size: Diameter.----------------------------------.Depth------- --------------------------------Liquid Capacity_--------------------------gals. Privy: Distance from nearest well--------------------------_----------------------Distance from nearest building_____.-_-___._____._______-_._.._-_-_---_. ❑ Distance to nearest lot line ------------- Remodeling and/or repairing (describe):---------------------------------------------------------------------------------------- -------•--------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ 1 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. (Signed) 'L "' --------- ----- --------------------------------------------------------(Owner and/or Contractor) ------------------------------------------------------------------ (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 ,:----------------------------------------------------------- DATE------------- Z 6 REVIEWEDBY-------------------------------- --------------__--------------- ---------------------------------------------------------- DATE BUILDING PERMIT ISSUED. ----------- --------- DA E. ------ c,+ Alteration and/or rec�_o/m/mendations:----- ' '�c.,��---- �� = ='`-'��---�----- --z-----�-----`----- ----- 791T✓. e -------------- --------- - _----'�---; -- ------- ------- -_ ----;------.---..----------------------------- ----------------- ---------------- ---------------------- --•-------------- ----- — —-------------------- - --------------- ------------------------------------ ----------------------------------.-- FINAL INSPECTION BY:.__-- -- - ------------- Date--_-__--r --/� — 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.P.0 C.