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FOR OFFICE USE: _------- �. _ APPLICATION FOR- SANfTATION PERMIT Permit No- ------------------------ ----------a-------------- - ----- (Complefe in Duplicate) /!S Date Issued ------------------------------ .-.--------..----- This Permit Expires 1 Year From Date Issued --�1___--------- 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 ANDATION--------, �=fQ Owner's Name------- - --. - - �U Phone.Address--------------------- - ---------•--------•--•------ ._.. Contractor's Name------ 0 ----\��a--6— -------------------------------- Phone Installation will serve: Residence Q"'Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: I----- Number of bedrooms Number of baths _/---- Lot size .--..-�--- -.r-.Q-- --------------- ------- Wafer Supply: Public system a--c-a-mmunity system ❑ Private ❑ Depth to Water Table -------- ft. Character of soil to a depfh of 3 feet: Sand ❑ Gravel [] Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe r pan ❑ Previous Application Made: (If yes,date--------------------) No Q.,olo�_ew Construction: Yes ❑ No H--- 9X/VA: Yes ❑ No K-- 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------..----.-.-_-_-_.-----__---.-------_----. -A-gs// I No. of compartments-----------r-------- ----Size--------------------------------Liquid depth------------------------.-Capacity--------------------- Disposal Field Distance from nearest well_---___----------Distance from foundation-----.--------------Distance to nearest lot line._----__._._._.-_ Number of lines-----------------------------------Length of each line---------------------------.-.Width of trench---------------------------------.- f' . Type of filter material-------------------------Depth off aterial----------------------Total length------------------------------------------ \ Se page Pit: Distance to nearest well- r-•------------DisGjce,4omu dation___ ___ _ istance to nearest lot/� - �' Number of pits____-I-------------Lining mate - .Size: Diameter--. ,�-i/------Depth----.--4? -____rte!_-- Cespoo Distance from nearest well-----------------Disndaticn__-.`._-_.-------- Lining material----..._------_--.-___._____/_-----.❑ Size: Diameter ------------------------De -- --- -------------------------Liquid Capacity-- --------------- ---------gals. Privy: Distance from nearest well.-_-------------- --------- -_�._a,._._ ---Distance from nearest building----.-----.--.-------.---_.---------._-.-. ❑ Distance to nearest lot line ----- ------------------- ---------------------•------- --------------------------------------------------------------------------1------ Re odeling and/or repairin {de tribe)__ ______ ________ �y. ( '1t C- Q� ---------- ---- . � ----------- ------------ --------------- ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Sfa wsapnd rut and regulations of the San Joaquin Local Health District. (Signed) �? ---- -- - -------- --- (Owner and/or Contractor) Ry%_-------------- � ------------------------------------------{Title} � R./�ss ' -------- -- -------------- (Plot plan, showing size of to afioin of system in relati n to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY x APPLICATION /ACCEPTED BY ------------------ DATE 1 - ` REVIEWEDBY------------------------- - --------- _ ----------------------------------- ---- -------- ----------------------------- DATE---------------- ----------------- BUILDING PERMIT ISSUED------------- - ----W--------- - ---------------- DATE-------- Alterations and/or recommendations:_-= �_.. ---------- ------------------------------------------------------------------------------------------------------------------------------------------••-•--------------------•--------------------------------------------- ---------- ----------------- ----------------------------- ----- --I--- ------- ------------------------------------------------- -------------------------------------------- -------------------------------- FINAL INSPECTION BY: .. ��--- ------ Date---- "/ -— JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California r•.P.r;o.