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F R OFFICE USE:- o w Ir ----- --------------------------------------------------------- .,APPtk!MN FOR =SANITATION /"�iMIT Permit No. -�_ _ - ------------------------------- ------------------------ (Complete in Duplicate) Date 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. 1 JOB ADDRESS AND LOCATION--------ef 4--.--/---------------------- ----- -----------------------------------------------�--- ------- ---------- Owner's Name 1 UD_ - ---- Owner's Address-------------------------------------------- --------- ----------------------------------------------------- -----------•-•-------------------------------- Contractor's Name--------------------------------- ----- ----------------- Phone------------__---_--------•------ Installation will serve: Residence ❑ Apartment House jZ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -------- Number of bedrooms -------- Number of baths -------- Lot size ____________________________________________________________ l Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand Gravei E] :Sandy Loam [Clay Loam El Clay El Adobe 2' Hardpan ❑ Previous Application Made: __ .. {If yes,date_ t - I No.[] 'New"Construction: Yes E] No E] FI IA/VA: Yes E] No El TYPE OF INSTALLATION AND SPECIFICATIONS: 4WVi. T� n/ C;^ - (No septic tank or cesspool permitted if public sewer-is available within 200 feet. :F Septic Tank: Distance from nearest well_________________Distance from foundation------------------- Material-- .--"__._._____...__________. ❑ No, of compartments- -----------------------Size---------------•-- -------------Liquid depth--------------------------Capacity----------------------- Dispos I Field: Distance-from nearest we1l_1f0j_..._Distance fr6M foundation_-�-----______.Distance to nearest lot line_______._____ Number of lines_-.___-_-_-�.__________-------Length of each line------------ of trench..�r_ -�_�_�.__________ Type of filter material-_ K_______...__Depth of filter material_____�'y_'�-��__Total length___________260________________ Seepage Pit: Distance to nearest well-.---- ______Distance from foundation-----------_--------Distance to nearest lot line______________ 04 l ❑ Number ofpits----------------------Lining material---------------- Size: Diameter-----------------------Dept h--------------------------------- 0 Cesspool: Distance from nearest well-------_---------Distance from foundation-------------------.Lining material------..-,-_.._________.________'_- El Size: Diameter-------------------------------------Depth--------- - - --------------------------------------Liquid Capacity- - ------------------------- Privy: -------- ---------gaffs. Privy: Distance from nearest well-----------------------_----------_-------------_Distance from nearest building------------------------------ _.____.--- ❑ Distance to nearest lot line------------------------------------ ----------------------------------- ------------------------------------------------------------------------ Remodeling and/or repairing (describe) ---l.--= `---- -- - ----- *"� - 7 -------------------•-------------------------------------------7_;_ ------------ - --------------•------------------------- ------------------------------------- ---------------------------------------------------------------------- ----------------------------•--•------- -- ---------- - -------------------------------------------------------------------- -------------------------------------------------------------------------------------------------------------------------------------------------------- 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 regulations/of the San Joaquin Local Health District, " r -------Owner and/or Contractor)(Signed) ------� . -- ----- By:--------------------------------------•----------------------------------------------------------------------------------- --------(Title)------------------------------- --------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY 'r APPLICATION ACCEPTED BY-------------------------------J40&--------------------------------------------------- DATE---- ----2._.�...r.(�.��r --------- REVIEWEDBY-------------------------- ------------- ----------- -------- ------------------------------------- DATE-------- ---•--------- ----------------- ---------- ----- - BUILDINGPERMIT ISSUED---------------------------------------------------------------------------------------------------- DATE------------------------------------------------------------- Alterations and/or recommendations------------------------ ---------- --------- - -----------••--•-------------------------------•------------------•--- --------------------------------------- ------------------------ --------------------------------------------------------------- ---------------------------------------------------------- ------------------------------------------ ------------------------------------------------------------------------------ ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- FINAL -------------------------------F€NAL INSPECTION BY:__ -- Co - --- --------- Date `�-- ----- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haselton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9Th Street Stockton,California Lad!,California Manteca,California Tracy,California r.P.co. v