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rul< ur-r-K.t Uz)t: : .... ... ........ ..... ...... A,_- ,-KATION FOR SANITATION PER,, _r Permit No. _,�- -,v... — > .. ....... ...... (Complete in Duplicate) .- Date.Issued ,- ..... . . This Permit Expires 1-Year From Date Issued { Application is hereby made to the San Joaquin Loca! Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549: JOB ADDRESS AND LOCATION` - "', �i-..-- jj - �a Owners Name--- f;F C �c-s FC --.-1`�l�l Ct Phone. - u-- / c ;�'y Address----------- --------�;. Phone--- -------------------------=----4 !?Contractor's Name-.-. - Installation will serve: Residence [ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: --.-�.- Number of bedrooms --- Number of baths -.1-.-- Lot size --- Water Supply: Public system ❑ Community system ❑ Private 2 Depth to Water Table ---_:- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy foam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan Previous Application Made: (If yes,date..- .-.....) No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ - No U TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well................Distance from foundation......___------. Material -.-...-................................ ❑ No. of compartments-----------------= Size--------------------------------Liquid depth--------- ..... Capacity....-- -.-- - Disposal Field: Distance 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 length----.-.------.-.----.-.---------------.--- See pa Pit: Distance to nearest well-...-. °........Distance from foundation.-----.�'-..........Distance to nearest lot line._ .-_--.-.._ Number of pits........1-.........--Lining material-------- -.j .-....Size: Diameter--------- ----- ----- Depth--- = --------------------` I Cesspool: Distance from nearest well-------------- --Distance from foundation...............----.Lining material___............................ ❑ 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}:------- -�-�- --- -- --r---•- -�----------------------------------------------------------- -- --- ----- -----�-------------�-----�-- --- -- ------------ ------------------ ---- ----------- ------------------------ -------•--------------f^ ------ -----------------------------------------•----- ---- --•----- ---- ----------------------- ....... .�t ----•---------------------------------------------- --••----------------------- -.----.--.....-.-...-.-.. I hereby certify that 1 have prepared this application and that the work will be done in accordance with San Joaquin County c'r- dinances, State laws, artd ru'-l-e- s and regulations of the San Joaquin Local Health District. 1 I (Signed)----- -- - ---- 1 '.f.--.-l;----- -- - - -- ------- - -- ------------- -__-`tomer and/or Contractor) ..r Title (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY.-- r�'''. `r�vr DATE- ............ ...............- REVIEWEDBY- - ----------- ------ -- - .-.--------.--- - --- - ---- ... -- - .-.------------------------ DATE--. .............. -.---- .-- BUILDING PERMIT ISSUED--- _-------_-_------------------ --------•--- -. DATE-----. Alterations and/or recommendations: - ----- ---................. -----------------------•----------------------- ------------------------------------ - - - - ---- ........................._. .- --.-...-.--.-.-- .....................-.._...-.......--...--.... ........... --- --- --- - - ...............___........................ FINAL INSPECTION BY:-.-..r.: _...__:::....:�: :.<'.i..... . ......... Date-. :P: :.w=•.,, ' SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.ffozelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton;California-- Lodi,California. Manteca,California Tracy,California— F-P.GQ.