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� 1 � APPLICATION FO,_ rANITATION PERMIT Permit No. .___!-�.�_.1____ (Complete in Duplicafe) / Date Issued ---Iell -- Applicationis'hereby made to the San Joaquin Local Health Disfrict for a permit to construct and install the work herein described. This application.. is made in compliance with County Ordin nce No. 549. JOB ADDRESS AN�DLO CATION_____-- �,��.. ,�Owner's Name_ zR2P-a �! �- -- ----- Addr -- . . . . Address � f h i �-- , Y c. '� _ - ---- ------ -----------• ----------------- ------------------- Contractor's Name--------- --- ----• f �y 1 ---- --------------------------------------------- Phone Installation will serve: Residence ❑ Apartment ouse ❑ Commercial Trailer Court ❑ (] to. Other Number of living units: -------- Number of bedrooms _____-_ Number of baths ______._ Lot size __ _-}w�__ ~� _ r --- Water Supply: Public system ❑ Commun'ity system ❑ Private Depth to Water Ta' :cll�_ f . D � Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam E] Clay Loa ay ❑ Adobe ❑ i Hardpan ❑ Previous Application-Made: Yes ❑ No New Construction: Yeses No ❑ FH�4/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: \ (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) I- s• _ .. . _ . .. �... ........ �-.. a.. Septic Tank: ..Distance from nearest well_ _-- _ -._____ - Distance from foundation___________________.Materia{______ - No. of compartmen[s- -------------------------Size----- ------Liquid depth--------------------------Capacity -- i. Disposal F- Id: Disfance-from nearest well______ _________Distance from foundation--------------------.Distance to nearest lot line___-------- :. Number of lines-----------------------------------Length of each line-----------------`----------Width of french-_------•---------------_---- Type of filter material--------------------------Depth of filter material------------------------Total lengfk'------------------------------ ------------ Seep iPit: t Distance to nearest/wellll��f-.------Distance from f undation--. Q:_:`._-•__.Distance to near o ine " Number of its___ - " p :Lining material-rr1 $ize: Diameter---- ==-- -------Dep _.__`- _ !/i------ C esspool: Distance from nearest well-----------------Distance from foundation-------------------_Lining material__-.._-------------------------------- Fl_ ___.___--- _❑ Size: Diameter-------------- ------- 1 - Depth = -------------------------------------Liquid Capacity-f---- --gals. Privy: Distance from nearest we]----------------------------------------------}--Distance from nearest building--------------------- ❑ Distance to nearest lot line__..____ --------------------------------- -----------------=-- ------- ---- i r Remodeling and/or repairing (describe):_____ j� � ^,�----------- J �--J---�-,--- - - 1 -.. „ ---------------- x ------------------- --- 1 herebyrtif th+i. have re a.ed t is a cation a that the rk w Y P p p� w ill be done'in accordance it San oaquin County ordinances, State laws,"and ru es:a d regulatior`s of the-Sam-Joaquin,Local Health District. t , (Signed)------------------ = ' _ " t -`�"�"==,. - Owner ani' Contractor -- ---- ------ By: - -- >..-------- ------------ Title-- --' .� c r. --- ;,-- '----- (Plot plan, showing size of lot, location of system in rela ion #o wells, buildings, etc.+ can be pla_ on revers side FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------------------------------- y -- ------------ --- -- ------------------------ --�-------------- DATE---- - -----• - -• '"' ------ ------ REVIEWED BY --------- ------------ - DATE �--�- } - ----------------- BUILDING PERMIT ISSUED =-------=- ------------------------•--------------------------------------- DATE-------------------------- aerations and/or recommendations:--__f'.:'___________________________. _ --- -- - --------•-------------------------------- ------------•- --------------•---- ---------•-------- - --- -------------------------`� �J :. - ---- - - - -- - ----,-fit--►- -- �--- . _------- 1 2 -------------- --------------- ----------------- -----------------------•------- ---------------------------------------------------------- Y- l { FINAL INSPECTION BY:------------------ - .; k Date --------- - g.. .. ------ SAN JOAQUIN LOCAL HEALTH DISTRICTp" 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, CaliforniaTracy, California SES-9-2M Revisep 1-57 F.P.CO.