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FOR OFFICE USE: i -- ----=------------ '� 6 --------------------------------------------------------- APPLICATION -FOR SARITATION PERMIT Permit No.'.................... (Complefe in Duplicate) Date Issued//�1�l-. __ ---,_____-- __ This Permit Expires 1 Year From Date Issued 2( 2.—f;ro—i(g 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 rmade in compliance with County Ordinance No. 549. JJ --------- ------------------- JOB AD?RESSAND 0 ATION__ _______ Owners Name------------- ----•-- ------•---- -• Phone------------------------------ ----------- - ------------------------------ -- �---I------•--------------- _ ------------------------------------ ---------- ------------------- --------- Address / Contractor's Name--------------- •-••--------------------------------------------------- - ---•------- •--------------- 7 Phone Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ----- Number of bedrooms -_- Number of baths -------- Lot size ------------ �--f�-- ------------------------------ Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table ----�71.� i a depth of 3 feet: Sand Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Character of soil to p ❑ Previous Application Made: (If yes,date---------------- ---) Nd ] New Construction: Yes El FHA/VA: Yes ❑ No [ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool.permitted if public sewer is available within 200 feet.) _. -- .•- .Material------------------------------------------------- No. --------------- ------------------ ----------- Septic T k: Distance from nearest well-----.._._______Distance from foundation__._________.__- - � No. of compartments--------------------------Size---------------------------- ---Liquid depth------------_-----------Capacity--•-•- ---------------- �t - _ Disposal Fielel. r Distance from neares well I0.a_.:_Distance from foundation----- -- --------Distance to nearest I t,lf,ir-_-� ----- �y Width of trench--------- F-------------------- -- ------------------ Number of lines Length Length of each line_____ls�_- �:_ �- . Type of filter material-S--1_ _-__ D.eptll of filter material_-__s2�.v__+_---Total length---------/0_ ____________________ Seepage Pit: Distance to nearest well---------------------Distance from foundation-------------.------Distance to nearest lot line----------------- El Number of pits----------------------Lining material--------- -----------.Size: Diameter------------------ ----.Depth--- --------- ------------------ t Cesspool: Distance from nearest well-----------------Distance from foundation------------------ Lining material .-______---.---------_- --.--. ❑ r Size: Diameter--------•----------------------------Depth------------------------ --------------------- - ------- Liquid Capacity ,._gals. - -_---.-Distance from nearest building Privy: Distance from nearest well--------------------------------------- - g---- ------------------------------------ ❑ Distance to nearest lot line----------------- ---------------- ---------------------------------------------------•---------------------------------------- ------------ Remodeling and/or repairing (describe)-------------------- --•--•----------- -----•---------•--------------•------------------------. -----------------------------------------------------•--------------------•--------------------•---------------------------------------------- -----------------------------------------------------------------------------------------------------•-------------------.. ------------------------- -------------------------------------------------•----------------------------------------------------------•------------------------------------- --------- -pared this application and that the work will be done in accordance with San Joaquin County ! hereby certify that I have pr .t ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signedg;// �4 lf-r --------------------------------------------------------- ------- --------------Owner and/or Contractor( By:_----------------------------------------------=------------- www------------------------------------------------------------(Title) _(Title) -------------- (Plot plan, showing size of lot, location of system in.rela#ion to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----------------------------- - --------------------------------------------------------------- DATE------------------------- ---------- - REVIEWED BY------------------------------------------------------------------------------ ------------------ _ _. DATE--------- -� — 1-�- ---� -- - BUILDING PERMIT ISSUED ---•- DATE------------------------------------------------------------- Alterationsand/or recommendations- -------------------------------------------------------------------------------------------------------------------••--------------------------------------- -------------------------------•--------------------------------------------- --------------------------------------------------------- R ----------- .-. _ �' - : ----------------- ---------- � -- FINALINSPECTION BY:. ------------------ --------- ------------ Date--------------------------------- -------- ------------------------------------ SAN JOAQUIN LOCAL HEALTH DISTRICT / 124 Sycamore Street 205 West 9th Street 1601 E.Hazelton Ave. 300 West Oak Street Y Stockton,California Lodi,California Manteca,California Tracy,California E5 9 17EV$s EO 9-59 3M 3-'63 F.P.CO.