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FOROFFICE USE: � -_ -� _. ��APPLICATIO_ NF0k SANITATION PERMIT _--_.... Permit No. --------------------------------------------------------- (Completein Duplicate) � This Permit Ex ires 1 Year From Date Issued C. Date Issued �� .l�--� 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 O inance No 549. JOB ADDRESS AND L AT N-------------- ------------•----------------•-•-••----•-------.._..-------------:::--•----------------•--••--- Owner's Name - - ==-_....... -----•- Phone........:................•----- Address.................... ----------- --- --------------------- .� � .�Contractor's Name------------ __...---------------- Pho4 Installation ._. ---- will serve: ResidenceApartment House❑ Commercial ❑ Trailer Court ❑ Motel [],-Other' Number of living units: .- Number of bedrooms ;Number of baths __/__ Lot size ._,r!O,C ___ _4_ 4................... t r Water Supply: Public system C] Community system ❑ Priv tav a„�epth to Water Table%$ ft. F,.M Character of soil to a depth of 3 feet Sand E] Gravel E] Sandy Loam ❑ Clay Loam [:] Clay ❑ Adobe[�. ardpan ❑ Previous Application Made: (If yes,date____________________) No ❑ New Construction: Yes P No �FHA/VA: Yes ❑ No Elt TYPE OF INSTALLATION AND SPECIFICATIONS: I (No septic tank or cesspool permitted if public sewer is available within 200 feet.) I e t nk:' Distance from nearest well_______-.___.-_.Distance from foundation_____________-------Materiel__ ....._-� """'r.” ...............I...... No. of compartments--------------------------Size._..-.----------- -- ---Liquid depth---------�------�.. _i_Capacity....................... al :11 Distance from nearest well-----------------Distance from„foundation....................Distance to nearest lof4ine................. Number of lines-----------------------------------Length of eachline------------------_----_-.Width oftrerich._:.f-----1___-:-----------..-.-• Type of filter material-------------------------Depth of filter 'material----------------__-----Total length----'-.......-...._.1.--------------- •-__-... Seepage Pit: Distance to nearest wel/Q(1__________Distanc fo dation__,-!��.------___.Distance to nearesf-lot line_c3�-___.- \ Number of its._._ ff Linin material-- *4 Diameter__r .3 ______.Depth_.��''.._---________ p /----------- g 1 Cesspool: Distance from nearest well----------------- from foundation--------------------Lining material-------......................____-_-_ ❑ Size: Diameter--------------------------------------Depth----------------- ---------------------------------Liquid Capacity-- I -----..-----gals. Privy: Distance from nearest well-------------------_--------__------------__ Qistance from nearest building---...-.._______________•••_.._.___-___.-. ❑ Distance to nearest lot line-------------------------------------- t Remodeling and/or repairing (describe):-------------------------------------------------------- -•-•-----•----------------..-...----- ..................................................... 41 --------------------_.......______-----------------------------------------------------------------.---------...».._...__._r___________.____...___._.___.__.___.__..____........____.....___._._.__________-__----._._._____ .......... •__________________________________________________________•-•__-_-_--___________-____-_----_--.-...-_.- I hereby certify that I have prepaflad this application and`thaf the work will be done in accordance with San Joaquin County ordinances, St laws, and r es and regula 'ons of the San Joaquin1ocal Health District. (Signed) ” --- ----- ----- and/or Contractor) _ 11 Br- --- - (rile} Q___�ner •(Plot plan, showing size of lot, location of system in relation to well ildings, etc., can be placed on reverse side). 3 FOR DEPARTM T USE'ONLY APPLICATION ACCEPTEDBY --------- ----------------------- DATE-.--/---- �.�........G� Z------------ REVIEWEDBY----------•-•----------------•------- - ---- ------_--------------------- ------------------- DATE.-----•----•••-----....... BUILDING PERMIT ISSUED-----------------------------------------------------------------------------^--- DATE. Alterations and/or recommen ations_-----------______ _____----_-------------------------------- ___� r _ ------------------------------------- --------------------------- _ ---------------------------------------------------------- 1 y FINALINSPECTION BY---------------------------------------------------------------- rF *{� Date-------------------------------------------------------- ---------------------- f I`[ SAN JOAQUIN LOCAL HEALTH DISTRICT il _ 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street y Stockton,California Lodir California Manteca,California Tracy,California B 9 EYI$EO 8-p9 ZM 5 A LAB r '�_