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FOR OFFICE USE: -- --------------- -- -------------------------------------- APPLICATION F(5R SA'NITATION PERMIT Permit No. ----------- --- ----------------- ---------- --------------- (Uinplefe in Duplicate) Date Issued --- - ---------------------- :Z--------- --- ........ This Permit Expires I Year From Date Issued T, Application is-hereby made to the San Joaquin Local rl 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 LOCATION----021 4 )--------------------------------------------------- ----------- - --- Owner's Name---------------------- ----42.A�_ ' ___n ----- - ------ ------ ........ —- ---------- Address-----------__................ --------------------- ----------- --------------- Contractor's ------------- ----- ------------------------------------------------ ---------- e.4/," _, .O_y Contractor's Name ---,: - --- ------- Phone...------- j Installation will serve: Residence J!J�A�artment ouse C] Commercial. E] Trailer Court E] Motel [_ Other 0 Number of living units: Number of bedroom;--?---'Number of baths Lot size ---------------------- Water Supply: Public system Community system D Private F] Depth to Water Table S_V_ ft. Character of soil to a depth of 3 feet: Sand 0 Gravel E] Sandy Loam 0 Clay Loo"m [] Clay 0 Adobe 0-"Hardpan 0 Previous Application Made: (If yes,date_J-049.....) No El New Construction: Yes E] No U?--"FHA/VA., Yes 7] No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: i I (No,septic.tankor.cesspoo.l.permitfed,if,p.ublic sewer,is,.avaiIabWwit1iin.200,feet.) Stic T n Distance from nearest weli-----------------Distance from fou nclation--------------------Material----------------------- ----------------L--------- No. of compartments______________ -----Size--------------------------------Liquid ------------------ CaRpcity-------------------- Di sal leld: Distance from nearest welI.A01%Ae_D. fance from foundafion._v&U_!._.---Distance to nearest lot line-1... ------- Number of lines Le.n,6fh of each line-30! Width of trench.... ---- -- ------- ---------- ------ A -a I------- ....... leng�h--------------- ---------- I Type of filter material al .,,-Depth of filter ma7fri g,ei�: kWn_Q_1 _J from foundafi S page Distance to nearest well--- - ------Dil -,It Distance to nearest lot fine_._- .... I a Number of pits--[..................Lining DiameTer-,3_ jP._. Depth--- _,R'S----------------- 0 4- 0 1 11� Cesspool: Distance from nearest well._._7n-----------Distance from foundation........7�--------Lining material------------------- ----------------- V 0' Size: Diameter---------------------- «--:Depth---------------------1-------------------- ---------Liquid Ca acify---------------------------- - -------------------------------- Distariti7r*orn nearest WeTl-..--------- -------------------- --------------Distance from nearest build;-Privy] # i ❑ D�sta�ce4o.re6r-est lofline----------------------I,----- ------------------------- ------------------------------------------- . --------------- 0 ClIp Ar 1 ` Remodeling and/or repairirig',�(clescri ------ ------ ------ --------------------------------------------- lop ------------------------------------------ ----------- ------- ----------- ---- -- ------------- ---------- -------------- ---—----- ------ ----------------------------------------------- 1jr -------------------------------- ---------------------------------------------------------------- ___----------- -- --- --- --- ---------------- --- --------- - ---- -- - ---------- -------------------------------- -------------------------------- ---------------------------------------------- ---------- -------------------- ----------- -------- ------------------------------ --- ---- --- - - --- - ------- - ------------- b. ---------------------—1 ---- ------------/----------------------------- --i-------------------------------------------- I hereby certify that I have prepare is application and that the work will be done in a cordance with San Joaquin County ordinainces, State laws rules and regulations,of the San Joa n at Health D' trict. (Signed)--- --------- ------ -- ------- ---------- - ------------------------ SEP T'IC NK A ---------- ---------------------- - ----- ------------ ---- - ---- ... . ...... ....... -(Title)------------ e'tc. n be placed on reverse side). (Plot plan, showing size of lot, location of sfi4fin in relation to well Z, n" FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY.............�A.. ---- - ------ ------- ---------------------------------------- DATE------- k l_-- ----------------- REVIEWEDBY----- - --------------------------------------------------------------------- -----------------------------------I------f DATE------------------------------------------------------------ BUILDING PERMIT ISSUED--------- ------- ----- ------------ DATE--------------------- ...... - -------------- Alterations ------------- ions --------- Alterations and/or recommendati :. 'I wtl' 7/-" ------------------------ -(/--------------------------------------------------------- -------------------------------------------- - --------------- ----------------------------- --------- ---------------------__--------------------------- --------------------------------- ---------- ----------------------- ---- --------------- ---------------------- -------------------------------------------- -I---------------- ------- --------------------------------------------------------------t------------------------------------------------------------------------------- ----------------------- --------------------------------- -------- - ---- -- ---------------------------------------- --;-------------------------------- -------------------------------------------------- - ---- ---- ------ --------------- FINAL INSPECTION BY:.__��--------- ------------- D, ---------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Harollon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P,120.