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FOR OF A E I ISE: b `3 Permit No. ....----- _ APPLICATION FORSANI7ATION PERMIT 3 ----- ---------------------------------------- ------ (Complete in Duplicate) f Da#e Issued ------------------------------------ This Permit Expires 1 Year From Date 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 AND OCATION...--- v!"" Owner's Name......- -yeal t_. - - - --------------------- -- ---------------Phone-----•------------------------------ Address---------- 3 " S E --•- !` -----------------------------------------•-•-------------------------------------------------------•----...--------------- Contractor's Name.---- � S ----------------------------------------------------------- -----•-------------------•------------•--------- Phone--------•-----------------•-------- ..---J--- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ....-- Number of bedrooms -�_ Number of baths -_1..-_ Lot size _..��-�---1st----•-------------- Water Supply: Public system [�ommunity system ❑ Private ❑ Depth to Water Table ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sa dy Loam ❑ Clay Loam E] Clay E] AdobeeHardpan ❑ Previous Application Made: (if yes,date-------------- -) No New Construction: Yes ❑ No HA/VA: Yes ❑ No [ . TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septi nk: fDistance from nearest well.................Distance from foundation-------------------Material---------------..------------...._---------.._.. T_. No. of compartments---------- - ------------Size-------------------------------Liquid dep? h--------- ----------------Capacity------------------. � Dispos Fi i Distance from nearest well..`.----..-....Distance from foundation. &-------------Distance to nearestlo��e_-�------__- ZZ Number of lines------I---------------------------Length of each line-3--- -------Width of french----_.........__................ --- � " GL� Type of filter material'.�1 Q _------Depth of filter.material----- �-._-------Total length--- ---Q--------..................... Seepage Pit: Distance to nearest well .'~..-___-------Distanc rom foundation__��_f_...._._.Distanc�e to nearest lot line.�__ ._.... NWOOumber of pits;_f -----------Lining materiap-ol C�C_ _...-Size: Diameter._.'3.4__---------Depth----.. 1}------------------- Cesspool: Distance from nearest well------------------Distance from foundation...................Lining material.__----------------------------------- . ElSize: Diameter.------------------------- ----------Depth--------------------------------------------------Liquid Capacity---------•-•----------------gals, Privy: Distance from nearest well----------------------------------_-------------Distance from nearest building----------------------._----_------------. ❑ Distance to nearest lot line----- ------------------ ---------------- --- ----------------------- ------------ ---------------------------------------------- ------ 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 regulatio s of t San Joaquin Local Health District. (Signed) ------ - ---- ----- ------------ F------------------------------ ------ ------(Owner and/or Contractor) By----------------------------------------------- ----- p ---------------(Title)----------------------------------- ------- ------ (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). F DEPARTMENT USE ONLY pp - - -5 ---- --- --------------------- ---------------------------------------- DATE------ •_T1 . f .. G3--------------------- APPLICATION ACCEPTED BY....... .. . . . . REVIEWEDBY------------------------------- ---------------------------------------------•---------------- DATE------------•-----------------------•---------------------- BUILDINGPERMIT ISSUED------------------------------------- --------------------------------------------- --------- DATE----------------------------- ------------------------------- Alterat' ns a ----- ----� n - - --------------------------------� -�-,�--=----------- -------•--------- ------------------:_----------------- ------------------------- ----I---------------------------------------------------------------- ------------------------------------------------- --- ------------- ------------------------------ ------------------------I----------------------------------------------------- --------------------------------------------- --------------------- ---- -- --•---------------------------------- / FINAL INSPECTION BY:........ -------- - ----------- Date. --------- --------- - --- -- 3 -------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haselton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 0 REVISED S-S9 3M 3-'63 r.P.Ca.