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R OFFICE USE: t l _ 1 ld / -------------------- ----------------------------------- APPLICATION FORJSANITATION PERMIT Permit No. .,l. 5-- 3- -- --- ----- (Complete in Duplicate) 3J � Date Issued G--S'�-----------------3.� 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 Cou4y.0rc11nance.No._549, d JOB ADDRESS AND LO ATION------------- __ ------ I----a---�(,------------- `--- I..--Lir-r-------------------- I Owner's NameG4 e ---------------------------------- ------ -- Phone------------------------------------ Address------------------------ Contractor's Name f X - � �-,�-•------ 4' ---- �' f1 �: ----------- Phone----------------------------------- ;/ Installation will serve: Residence" sa Apartment House E] Commercial E] Trailer Court [:] Motel El Other Number of livingunits: _ -6-- Number of bedrooms _ Number of baths/------ Lot size - . o-�.S,�_9�1,a ,�______________ Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table _ ft. Character of soil to a depth of 3,_feet: Sand ❑ Gravel E] San Loam [—] Clay Loam E] Clay ❑ Adobe ardpa Hn _ ❑ Previous Application Made: (If yes,date----------- No New Construction: Yes D No FHA/VA: Yes ❑ No [t•.. TYPE OF INSTALLATION AND SPECIFICATIONS: ,% (No septic tank or cesspool permitted. if public.sewer is available within 200 feet.} Se tic Tank: Distance from nearest well_________________Distance from foundation--------------------Material------------------ --___.._________---__..____-- l�✓ No, of compartments — Size__`_`__�� - iquirsT --- d depth--------------------------Capacity----------------------- Disposal Field: Distance from nearest well..��^-------_Distance from foundation_/0_.....___-Distance to nearest lot line--.S----------- a.0y ff/�✓ Number of lines------ ----------- - Length of each line-_-____-a!3__/_.--------Width of trench-.Q._vzl------------------ Type of filter material__./L D{�Depth of filter material____.. _1Total length--____-:3,a Seepage Distance to nearest well___--- Distance from^foundation-__1 v_�___.___ Distance to nearest lot line__-... . ------------ r I Number of pits------I-------------Lining material ��_h�------Size: Diameter--a-3..!�.-------- Depth ---_--t om,['` / --- Cesspool: Distance from nearest well-----------------Distance from foundation__.-----------------Lining materiaf-___--.____-_..______-__-_____.___. ❑ Size: Diameter-------- ------------------------- -- Depth------------------------------------------- --------Liquid Capacity------------------ ---------gals. N Privy: Distance from nearesf well '_:._:_._: - """`----_____Distance fromnearesf'buildin S ❑ Distance to nearest lot line------------------------------- ----- --------------- -----------------------------r------- ----------------------------------------------- Remodeling and/or repairing (describe):___-__._-___---�--- �,,��.�- ---------------------------------------- ----------- --------------•------------- ------- --------------------------------------------------------------------------------------•------------•----------------------------- ------------------------------------------------ ---- -I' -- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- I hereby certify that I have prepared this application and that the work_ will be done in accordance with San Joaquin County ordinances, Stat?aand rules egulafons of the San Joaquin Loci[ Health District. (Signed) Q ---- ------------ ----------------------------------------------(Owner and/or Contractor) B ----------- ---------------(Title)--- (Plot plan, showing size of of system in relation fa wells, uildings, etc., can be placed on reverse side]. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY- a R---------------------- DATE-----7 =- - -- ------ --------------------- ---------------------- REVIEWED .. REVIEWEDBY------------------ ------ --- -------�---------- - ------ -------------------=--- --- --------- DATE----------------- ----------------------------------------- BUILDING PERMIT ISSUED----------------- - ----- - DATE----------� - ------ Aiterafions and/or recommendations: ~ -------r c.�;,--:!-; .` •---•--------------------------- ------------- -------------------------- ---^------------------- ----------- --------- -- -------------- - ------------------------------------- _ ------- ---------�=-` f/ ---------------------------- FINAL INSPECTION BY:.- -- - - ------------- ........------ Date--- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hoselton Ave. 300 West Oak Street : 124 Sycamore Street 205 West 9th Street I Stockton,California Lodi,California Manteca,California Tracy,California r.P.CQ.