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JJ _ J � ........... ......_--- ------------ ---.___..----_-- APPLICATION FOR SANITATION X�RMIT Permit No. ..1.. /_. % ------------ ------------------------- (Complete in Duplicate) --- ------ ------------- ------------------------------ This Permit Expires 1 Year From Date Issued Date Issued ..S /f__4 Application is hereby made to the San Joaquin Local Health District for a permit to construct and insfall the work herein described. This application is made in compliance with County Ordinance No. 549. JOS ADDRESS AND LO ATION---------r1Z 2 t9Q �/f ----------------------------- Owner's Name----------- Phone--- ------------------- . t. GfQ`- /�7(Jr✓l� � - Phone-- - -------- � -`.-- ---- Address--------------W: q --------- --e- �--- ---��-- Contractor's Name---- --------- Phone. Installation will serve: Residence I� Apartment House ❑ Commercial [I Trailer Court ❑ Motel [❑ Other [ Number of living units: ----)__ Number of bedrooms ._2_Number of baths/------- Lot size ----------------------- Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table_ ft. Character of soil to a depth of 3 feet: Sand p Gravel ❑ Sandy Loam ❑ Clay Loam [j Clay El Adobe ardpan ❑ Previous Application Made: (if yes,date....................) No ❑ New Const uction: Yes [],Jog FHA/VA: Yes 7] No TYPE OF INSTALLATION AND SPECIFICATIONS: 9DuvSe r>\P (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic T Distance from nearest well.- - . --------Distance from foundation.�Q-�_____Ma eriaLe�C J� No. of compartments._---.._ Size-_-- Liquid de the Disposal Fd: Distance from nearest weil_1_--/---Distance from foundation-�._�-__-Dlistance to nearest lot line.. -------------- Number of lines--------- Length of each line.___--. -- ---------- ----- 9 Width of trench.- - ------------------- Type of filter material._f�_4��--De Depth of filter material--... _ ____--Thal length------ �Q.___!_______ p ------ 10 Seepage Distance to nearest well---------------------Disfance fr foundation.AQ..r._.-.Distance to nearest lot lin t5 Number of its-_-. .__ _. . ._-_- N p ----- - - Lining material._- (__Size: Dia mefer.__,.��...�--.Depth�.,�../��___ Cesspool: Distance from nearest well-----------------Disfance from foundation--------------------Lining material-_....._------ ..------------ ------------ ..__..-..... TT ❑ Size: Diameter--------------------------- ----------Depth---------------------------------------------------Liquid Capacity--------------- -----gals. X APrivy: Distance from nearest well---------_---------------------------------------Distance from nearest building ❑ Distance to nearest lot line Remodeling a or epairing (describ .----------- - - - - -------- .moi ---- --------------------------------------------------------------------------------------------------------------------------------------------------=----------------- - ------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance-- --with San Joaquin County ordinances, State law/"a rules ands-e tions of the San Joaquin Local Health District. (Signed) // (Owner �nd, r Contractor) By-------- =-- - - ------- -- -------------- ----- ---- --------------------------------- Title , f ) (Plot plan, showing lat, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY r APPLICATION ACCEPTED BY-- DATE - /l- , ---------------- REVIEWED BY ------ -------------------------------------------------------------------------------- DATE ---------------------------- BUILDING PERMIT ISSUED ------ -------------------- - DATE-- -------------------------- -- Alterations and/or recommendations:..._, -/l--�r.. ---..-_ ----Z :L-_-- --------------------------------------- ---- -------------- ------------------- ------------------------------------------------------------------------------ --------------------------------------------------------------------------------------------------------------------------------------------------------------- --------------------------- ------------------------------ - FINAL INSPECTION BY: k//_ Datec_��.-. SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9Th Street Stockton,California Lodi,California Manteca,C011fornia Tracy,California