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FOR OFFICE USE: - ' r 3° APPLICATION FOR SANfTAT10N PERMIT Per No. ..�--•---� •-- ------ ------------- -- a (Complete in Duplicate) Date is suesd _-_-• --- -- _ F________________i_.-____-____._ This Permit Expires l Year From Date issued -------------------------------�..------ _=- Local 'Ordinance District for o a permit to construct an Application is hereby made to the San Joaquin d install the work herein described. This application is made in compliance with County 2 Oto ' JOB ADDRESS AND LOCATION ---------=----- -------• Phone -------------------------•---- Owners Name'.. -_._ n'" ' g� if=-�_��--- -----$-•-------------- -•--------•--...------------------------------------------------- Address -----` — Phone one............. ................. Contractor's Name------ ------------------- •-------- Other installation will serve: Residence �parFment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ ❑ ._ _.i-3. .-- ----------- __-. Number of baths l._... Lot size -__- Number of living units: _�__.-_ Number of be .3- Depth To Water Table left. Water Supply: Public system [�ComMunity system ❑ Private ❑ p Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Y FHA/VA: Yes ❑ No 2--_ Previous Application Made: [If yes date.__.___--._.__-----) No I� New Construction: Yes �No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.] r v'Ul r Capacity ---- Septic Septic,/Tank: Distance from nearest well from foundation._O...__--------.Materia___1_& __.p ty g � --------------Size__3.Ax-X. _f--------Liquid depth=_.. _ .. No. of compartments_-___.______ _ foun Disposal"Field: Distance from nearest well_- --Distance fromch I ne��° ----------------- W dth ofttrencheSf!.�'t lot ne- Number of lines_-____�------------------------Length of eaIt r Type of filter material._._.�, -C,_�------Depth of filter material.Z�--------------Total length-----...---•-•-------•--•---•------•--•-- l Seepage.Pit: Distance to nearest welk____7~----------Distance ro foun S Zie np e efer-_._3}-3ce to nearest l�t�ne_�'.•----- P mac. Number of pits.-- --------------- material-'_ -00c 1 _ Cesspool: Distance fs•om nearest well-----------------Distance from foundation-- ---------___:-Lining Capacity el•--_--------------------------gals. i --------------••---------- ❑ Size: Diameter -------------Depth__._----------------- - q "�_a-----Distance from nearest building------------------------------------------ 'Privy. Distance from nearest well----------------------------- , ----------- i ❑ Distance to nearest lot line . --------------------------------.J - --------- ...... Remodeling and/or repairing (descrq e):_-__.------------------------- --------- -- r ------------------------ ----•------------•-------•----------------------------• - - - - - - - - - - -..... - --------------------------------• ------------- - ------- --- ------ ----- ! 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 S n Joaquin Local Health District. [ -----------------••------•----...------------[Owner and/or Contractor] (Signed)_ - -- ----- --- ---•- -(Ttle)---------------------------------------- BY� ------------------------------------------------- --- buildings, etc., can be placed on reverse e. r (Plat plan, showing size of lot, location of sys+em in relation to wells, si FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED f -- - --- ---------------------------------- DATE---- ----- • ----------------•- -- ------ DAT _.-- ---- -•-------•-•--------••-------••--------------- REVIEWED BY---------------------------------------------------------- ------ ---------------------------------------------------- _ DATE. __ _ BUlLD1NG PERMIT ISSUED__.. „ - / Alterations and/or recommendations:.,`-5-- --------------------- ---- ------------ ------------------------ ---- i .. 1� ��/ Date---- _-.- -- -- ---- -- -- -- -- FINAL INSPECTION �� -.-- ---- --- F SAN AQUIN CAL HEALTH DISTRICT 0 144 Sycamore Street Tracy, West 91h Street 3 Wast Oak Street 130 South American Stra+t P Manteca,California Tracy,Caiifornla Stockton,California Lodi,California ES 9 REVISED 8.59 ZM 5-$2 ATLAS