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I-UX cel-HU: IJSt: APKiCATION FOR SANiTATiON PERM Permit No. AZ:2_'_1._ --------------------------------- .--- - (Complete in Duplicate) Date Issued _....... I This Permit Expires l Year From Date IssuedT.�....-_- I Application is herebymade to the San Joaquin Local Health District fora er construct a d i I the w rk herei dWL Thisapplication is made in compliance with County Ordinance No. 549. p � lCFz EJ JOB ADDRESS AN LOCAT N_.--IC'-7`--6-1 . --4. ' -� QOF—.. z ? E Owner's Name---- - ------ --------- ------------ ...................... Phone--g.�./'^- f . Address------------` = ,�� ,./ ------------------------- Contractor's Names. L • - Phone...7`-�tF'. � Installation will serve: Residence E] Apartment I House E] Commercial railer Court ❑ Motel ❑jot r ❑ Number of living units: -------- Number of bedrooms ___'____ Number o£ aths -------- Lot size _ .C._ ' .-.-_.._............... Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table -------- ft. Character of soil to a depth of J feet: Sand ❑ Gravel ❑ 'Sandy Loam;❑ Clay Loam ❑ Clay ❑ Adoberdpan ❑ Previous Application Made: (If yes,date...__ ___.-_---__-.} No ❑ New Construction: Yes ❑ No �HA/VA: Yes ❑ No ❑. TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer,is available within 200 feet.) z� Selnvc ar Distance from nearest well--------------- Distance from foundation.........--._.-----Material.........................._-._-------.._.._..._. ��,['� No. of compartments--- ---------- -----------Size--------------------------------Liquid dep�h---------- -----.---------Capacity----- ------------- ostl Ad- Distance from nearest weli_t�_CC-'fDistance from foundati ��.--_---.Distance to nearest lot Number of lines------Z-...__..1..-_/`]......Length of each line��. ---_.Width of trench_ .,"_-_-__..-._-.__ Type or filter materi� dl.�_..Depth of filter material-__-0'_ _____Total length_,�.�a_..: Se �ge - Distance to nearest well____---.- Distance from foundation....................Distance to nearest lot line...........__.--- % Number of pits--- -------------------Lining material----- -----------------Size: Diameter---------------------.-Depth---------.----------------------- Cesspool: Distance from nearest wed l-_...___.. ---Distance from fol.indation....................Lining material.......--_-_------.._...-------...... ElSize: Diameter Depth Liquid Capacity----------------------- gals. S Privy: Distance from nearest well .............._______------__------._.-.-.....Distance from nearest building------------------------------------------ El Distance to nearest lot line- ----- --- --------------------=--------- ------ Remodeling and/or repairing (describe):- - - ------------------------------------------------------------- J --------------------------------------------------- -- - ----------------- --------------------------------- --- --- = ----------------------------------- ------ ---•------------------- -•---------------------------------------------------------------•-------- -------------- ----------- I hereby certify that I have prepared this application and that the work will done in accordance with San Joaquin County ordinances, State laws, and rules an regulations he SanoJoaq ' �ALocalHeDistrict�`-------- Contractor) By:---•-----•------•-• .....-- -------- ---- --- Ie) =(Plot plan, showing size of lotflocation of system in relation can be placed on reverse side). E FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------- - ----- DATE--------------- �6 - ------------ - REVIEWEDBY----------------- ------ -------- ---------- - --------------- --- ------------------------------------------ ---------- DATE----------------- -------------------------------------- BUILDING PERMIT ISSUED------- DATE / Alterations and/or recommendations:....-y �5� �._._____ .-.-_, o _..-_._.� xz_ L�..A`--- aace ..................... ------------------------------ ----------- -- [/ � � --=-- ------ <- -----��- f - ccrM K= - .. ------------- ----------------- -------------------------------------------- --------------------------------------- ----------------------------------------- ------- FINAL INSPECTION BY:-----........ _ �c --- -------------------------------- Date-- 1 -------------------------------------- SAN -- -SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haxelton Ave. 300 West Oak Street 124 sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P-C O.