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FOR OFFICE USE:: w APPLICATION FOR S6NITATION PERMIT Permit No f ....--..- --------------------- --------------------- -- -------- (Complete in Duplicate) Date Issued -------- This Permit Expires 1 Year From Data Issued 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 AtO LO -ATIO ; 3.70--- !f- ±I------- ----- -----• ------------------------------------------------------------------------------ Owner's Name------ ? --------------------------------- Phone Address--------/ 7 tlu :. -f. t�/', ------- Contractor's Name---- -------- . �f 1✓ -------------- Phone Installation will serve: Residence Er Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ---I--- Number of bedrooms _ -_ Number of baths ---I---- Lot size --.- --__._______----------------- Water Supply: Public system ❑ Community system ❑ Private ❑ Depth to Water Table 3�0ft. 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 PT""New Construction: Yes ❑ No 731"yFHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ^u Septic nk:` Distance from nearest well-----------_-------Distance from foundation-------------------Material._______-__.__------.--_-______-.__ --_-_-__._. No. of comparfiments___.___..__- -_._ ------Size--------=-----•--------- Liquid de th.------------------- - ---Capacity---------- Disposal Fi d Distance from nearest weEl-- ----------Distance from foundation__f0'-------------Distance to nearest lot line_I.S----f____-. Number of lines--------- _�.�.--.-Length of each linte_.�1 - ____________.Width of trench- .y__________________ ✓r �y Type of filter material--- 4'7___..__-----Depth of filter ma e I_./�*`._-_____Total length_._��_'�____________________._-- N Seepage Pit: Distance to nearest well------—--- --------Distance from foundation---/IV---_------Dista`ce to nearest lot linn�_-____..... Number of pits_____.--------------Lining material__ !?!- -size: Diameter___ . __: __-_____.Depth___. ___: ____.___.__ . O Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material--------------------.__-.-.-__-_-_--- i ❑ Size: Diameter----=----- --- ---------------'----Depth-------------------------------- -------------------Liquid Capacity- --------------------------gals. Privy: Distance from nearest well--------------------------------------------------Distance from nearest building----------------------------------------- F1Distance to neo est lot line--------------------------------------------- -------------------------------------------------------------------- ------------ :, i Remodelingand/or repairing (describe):--------------- -------------------------------------•------------------------------------------ ----------------------------------------- ------------ 111 � ------------------------ ------------------------------------------------- ------------- ------------------------------- -------------------------------------------•---------------------------------------- ------------------ -------------------------- ---'-------`-------."---------------------•-------------------------------:---------------------------------------------------------------------------------- I hereby certify that 11 have prepared this application and that the work will be done in accordance with San Joaquin ounty I ordinances, State laws, and rules andel regulations of the San Joaquin Local Health District. -- `- 1"rw�fti ----------------------------------------- - -----Owner and/or Contractor) (Signed) -- ----6 ----------- k Title (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). r � ' FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED' BY .. �" - DATE JZZ REVIEWEDBY----------------------- ----------------------------- -- ------ DATE------------ ----------------------------------------- BUILDINGPERMIT ISSUED----------------------------------- --------------------------------- ----------------- DATE------------------------------ --------- ---------------- --- Alterations and/or recommendations:.-.-------- "_/ '-G =�J ----------------- •-------- ---------------------------------------- ---- ------------------------ --------- --------•---------------------•------------------------------------- ----------------------------------- - --=-------------- -- ------------------- k ----------------------- ------------------------------------------ oe _ --•- Date--- -`/�� -`-(: _-------- ------------------------------------- FINAL INSPECTION BY_________ _________ __ SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haxelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton;California Lodi,California Manteca,California Tracy,California ,F.P.CO.