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t Permit No. . ` APPLICATfON-- F OR SANITATION PERMI _ ►___ __ _ _______ _ _________ --------------_ (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 on ismade in compliance with County 9rdinance No. 549. JOB ADDRESS AND LOCATION--------f�-1--- % ' f ~'-�----------- 2ii�CCI------------------------- ------------------------ ------- JOB e r Owner's Name rj-- ��gg / = 7 ,c-------- ---------------------------------- X -------------------------------- Phone ---°------- -Y- f > ----------•----------------------------- i Address------------------------------ /------------` �- = '= Contractors Name___---__.___ n � ` / r � 7 - ! - ------- Phone----------------------------------- Installation will serve: Residence ®Apartment House E] Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -_/__._ Number of bedrooms ----Number of baths ---j___ Lot size __ � - ---------------------- Water Supply: Public system ❑ Community system ❑ Private ❑" Depth to Water Table ., -- ft. + Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam D-tlay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: jlf yes,date--------------------) No E]-`New Construction: Yes ❑ No Ej/FHA/VA: Yes ❑ No ❑-' TYPE OF INSTALLATION AND SPECIFICATIONS: . (No septic tank or cesspool permitted if public sewer is available within 20R f et.) A, _Material--__------ Septic Distance from nearest we :_ 1_Ve_Distance from foundao __ ___________ ---_---__Siz q 41 Li uid de th____ _-_ Ca- acii`Y X= � fe/No. of compartments__-_____ _ Disposal Field: Distance from nearest _.Distance from foundation___- / .Distance to nearest lot [� Number of lines___________ Length of each line---eyv_n---_ __-_ ---Width of trench - ---------------- �i Type of filter material- Depth of filter material----I .............Total length------co--- ---------------•----- Seepage Pit: Distance to nearest well----------------------Distance from foundation----------_---------Distance to nearest lot line--______________ 0 ❑ Number of pits----------------------Lining material----_------------------Size: Diameter-------------------------Dept h--------------------------------- k Cesspool ool: Distance from nearest well-----------------Distance from foundation- _ _ _ - __________ ___.Lining material____-_______-----______ ____ ___ _ � p ❑ Size: Diameter------------------------------------ Depth----------------------------------------------.-----Liquid Capacity---.------------------------gals. Privy: Distance from nearest well----------------- ------------------------------Distance from nearest building-__---_______-_____-__________-----------. ❑ ---------- ---------------------------------------------- Distance to nearest lot line__-__-. __ Remodeling and/or repairing (describe]'- ----- �G�-.:-x---------�"--�� •=------,}-------�-� ------ ----------- - I ------------•--------------------------------------------------------------- --------------------------- = - �� I hereby certify that I have prepared this application and that ithework will be done in accordance with San Joaquin County ordinances, State laws, and/rullS"3ndregulatioA!M6%TheI`S n Joa utn Local Health District. � (O Ener and/or Contractor) (Signed)----'--'--_-----'------------- � -- -- BY:-------------- - r -,-- ---------------------------------------------(Title)------ ,------------------- ------------------ showing of of location of s stem in relation to wells, buildings, etc., can be placed on reverse side). g size (Plot;.plan, FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY--------------------------------------------------------- ------------------------------------- DATE------------------------------------------------------------ REVIIWIDBY-------------------------------•------------- -----------------'---::------------- P�----p------ DATE------------------------------------------------------------ �} BUILDING PERMIT ISSUED---------------------------------------------------------------------- - --------------- DATE------------------- ----------------------------- Alterations ___ ____________________ __Alterations and/or recommendations:---------------- �' -- , +- ----------- f ------------------------------------------------------------------------------ ----------=----------------------------------------------------------------------- k ------------------------------ 'PX _ _ _______________________________�-_.______-__il------ �-- ----------------------------- k I SAN JOAQUIN LOCAL HEALTH DISTRICT i1601 E.Haxeltan Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street �r + Stockton,California Lodi,California Manteca,California Tracy,California