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FOR OFFICE USE: -------- ----- �� p L � � APPLICATION FO-R SANITATION PERMIT Permit No. .. _ _ - _ _ __.___ (Complete in licate r P ) Date issued .J 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 is made in compliance with County Ordinance No. 549. + Ij /1 JOB ADDRESS AND LOCATION: a v �'------------ ,....,.._' "---i------------ - 3f�-� Owner's Name_ "-( 1- _--�.`a" Phone .qf. ._ I Address _ _ ? - '- !k -- -----••----- -----------------------------------------------------------------------------------`------------ Contractor's Name �,,.,,/v� ------ --------- -------------------------- -- ------ Phone-- (� Installation will serve. Residence E' Apartment House E] Commercial E] Trailer Court E] 'Motel E] Other [1 0 Number of living units: ---- __ Number of bedrooms _,4. Number of baths _I.._- Lot size --_ ._ i U___._ Water Supply: Pubic. system Community system El Private ❑ Depth to Water Table -----._ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ San Loam ❑ Clay Loam Clay ❑ Adobe.0 Hardpan ❑ Previous Application Made: (If yes,date_________ __________) No New Construction: Yes ET No ❑ FHA/VA: Yes e !No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: I P (No septic tank or cesspool permitted if public sewer is ava�,kr'a61e- n 200 feet.) t �� Septic Tank: Distance from nearest wellA3-0-- Distance from foundationTQ__-___-.____.Material... A4 Disposal ®� No. of compartments_.`_-�_ ----------- � s t Size 'C,2--9------Liqu;d depth-------`r -----..Capacity- .- 4A ------- Disposal Field: Distance from nearest well_k�R—___-_._Distance from foundation__/_____________Distance to nearest lot line--- _.___.... Number of lines------�______.__.____________________Length of each line----?0--------..._-____.Width ofh __ ___.._____.____. TYpe of filter matenal_'-1?a-.4tt--------Depth of filter material_-Zl- length_.-qk�_`---------____________________ r If i p g Number of its----L----------------Lining material_--_!Ro_....�-----Size: Diameter____._:-3s�._�._._.Deptn___.__�r£`�1 ` ` See a e Pit: Distance to nearest well.-/0---------------Distance from foundation___________-_._ Distance to nearest lot ine_. Cesspool: Distance from nearest well-------_---------Distance from foundation----------____.._..Lining material-----.-------------------------------- [] Size: Diameter_.".."".-. -------------------Depth----------------------------- --- --Liquid. Capacity-. Privy: Distance from nearest well-------------------___----------..-------------Distance from nearest building. ------------------------------------ r Distance to nearest lot line-------------- r I I � l Remodeiing and/or repairing`(describe):---------- ----------- -----------------------------------------------------------------------------=--------------------------------------', --------- ---A-!--------------------------------------------------------------------------------------------------------------------------------------------- ------------- ------ � --------------------------------------------------- ---- ------------------------------- --------------------------------------------------------•---------------------------------------------------------- ---- - r II`r`rI 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, and rules and regulations of the San Joaquin Local Health District. (Signed)--------------------------------------I---------------- ------I------------------------ - - -------------------------------- ------------ {Owner and/or Contractor) Y - --------g---------------------------------------- --------------. -------------------------------------(Title) ) '�------------- (Plot plan, showing size of lot, location of system'in m%fation to wells, buildings, etc., can be laced on reverse side. i FOR DEPARTMENT USE ONLY l! APPLICATION ACCEPTED BY - ------------- ---------------------------------------------- DATE- 3 "' REVIEWEDBY--------------------------------------------- ------------------------ ---------------------------------------- --------- DATE----- -- -------------------------------------I-------------- BUILDINGPERMIT ISSUED------------- — --------------- E-------------------------- --------------------II------------- I Alter ions a d/or recomm ndation.•_____________ _ r . " ' _- - - - - ------------ Y - - ------'rte- -�� -- ----------------------- - --- -w , iJ ,Q_- r � � - , b 7 , FINAL INSPECTION BY:------ -------------- r Date---- - ------- --------------------------------- R SAN JOAQUIN LOCAL HEALTH DISTRICT N s i 1601 F.Hoxeltan Ave. 300 West Oak Street 7f24 Sycamore Street a 205 West 9th Street r Stockton,California Lodi,California Manteca,California Tracy,California it h F.P.CC. ii