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FOR OFFICE USE: p / ---��-�-5--�--� ��-- �-'-=�-b- - --- Permit No. 1,/-.�(�. -------------------- APPLICATION EOR SANITATION PERMIT (Complete in Duplicate) Date IssuedJ- ___ ___-___._._-- This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Healf District for a permit to construct an install the work erein described. This application is mad compliance with County Ordi e No. 549. JOB ADDRESS A OCATION----- ---�[--- -------- ------ -- - - -- -------^------ --- - -------- --------- -- ------------ Owner's Name----� -------- - - - --------------- ------ -------------------------------------------- - Phone-- _-- --T` �r �1 ---------------- ---------- --Address � ...r_ � t Contractor's Nam - ---- ----- Installation will serve: Residence& Apartment us ❑ Commercial ❑ Trailer ourt ❑ M I �❑ Other ❑ Number of living units: _1_-_ Number of bedrooms -- - Number of baths _j_-_ Lot size -- -------- Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table _ t. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam (] Clay ❑ AdobeHardpan ❑ Previous Application Made: (If yes,date-_.___.,-..--------) No ❑ New Construction: Yes ❑ .No FHA/VA: Yes ❑ _ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic A or cesspool permitted if public sewer is available within 240 feet.) S e: Distance from nearest well_________________Distance from foundation-------------------Material--------------------------------------------____. No. of compartments------- ------------------Size--------------------------------Liquid depth---------------- ---------Capacity----------------------- eIel 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--------------------------------_--------- S ______-_ Seepa e Pit- Distance to neare t well__jV ___._.__Distance rom oundation__, ----------Dista!� to nearest lot Gne----��_--_._. Number of pits---- --_._____-_----Lining material_ _f?. Size: Diameter_56________._Depth- ._____----__.__ Cesspool: Distance from nearest well-----------------Distance fromI undation--------------------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 (delcribe]: = -' -------------------------•------------- -------- ti -- ----------------------------- - ----------- -.- - --------- .i --------------------------------------- ` --------------- -------------- -•---------- ----- ------------------------------------- -----------------------------------------------------•--------------- ------------------------------------------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, an les and regulations of the S quip Local Health District. 2a� & l4t (Signed) ----------i� --------- - ----- -- - ------------------------------------------ -- :.Contractor) SEPTTG TANK Sit VIC BY: - --- - -- �, 04., (Title) (Plot plan, showing size of lot, location of system in relati to we buildican be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---------------- ------------ ---------------- DATE-----Z//- -�– �— REVIEWED BY r• ------- -------------------------- DATE -------- BUILDING PERMIT ISSUED----------------- -- . ------... . ------- DATE------------- Alterations and/or recommendati ns:__�__. --------------------------------------------------•------------------------ -- - ------------------------------------------------------------------------------------------------ -------------------- ---------- ----------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------ ----- - --------------------------- - ------- ---------------- --- - ----------------------------------------------------------------•--------------------- ----------------------------------------------------- --- Date --------- -- --------------------------------- FINAL INSPECTION BY �.-- -- ---�1-1.��- - --------------- �' SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Maxeltan Are. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.CO. h.