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FSROFFIC 5E 7 7a f i No. + -- -- -- l' ---_. APPLICATION FOR SANITATON PERMIT Permit + _rd ---- ---- ------ - ----- ------ --- ------------ (Complete in Duplicate) Date !s t!S sued --------------------------------------------------_____ 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. JOB ADDRESS AND AT N_. /_ __--.____ _._ r . it Owner's Name---------------- ------------------- - i --------- , ------------------------------ -:.-_ Phone---k-------------------------_---- Address------ -------•----Address----•- •-------- -----> � - .--•---- , Contractor s Name______._.. Phone ,l Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ -A , Number of living units: _--`_____:Number of bedrooms n-9. Number of baths�__ Lot size 6--d __ _�_____________---------- Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table _1 lift. Character of soil to a depth of 3 feet:; Sand ❑ Gravel ❑ Sandy Loam ❑ 'Clay Loam ❑ Clay ❑ Adobe 9-0'—Hardpan ❑ Previous Application Made: (If yes,date---------- 1 No New Construction': Yes ❑ No �A/VA: Yes ❑ No [�..^. TYPE OF INSTALLATION AND SPECIFICATIONS: t t (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic, Tank:; Distance from nearest weN_________________Distance from foundation____-4------------ Material______._____-_. .___.._____-.____._________. � Giallo, of compartments Size Liquid`dept` +----------------- Capacity-----------•----- Number of lines___.__._____... �, Length of each line__ Width'of trench.__` Disposal Field: Distance from nearest. well--- _-- --Distance from fcundat�-� -------Distance to nearest lot line__a-__________ l �.- r ype of filter materia l` G/�`_Depth-of filter ma#eriaL_ ___.._Total length----�fs -_______________________ Seepage Pit: Distance to nearest well________ -----------Distance fro fo ds ze n---/�f stance toneare's'tlot €i e_ Number of its_____ Linin material__ L r Cesspool: a Distance from nearest well_________________Distance from foundation.--------------------Lining material-----c---------.------------_____--__ Size: Diameter Depth `--�------------------Li uid Ca acit I'-------------------------gals. y❑ P ___._.__Distance from nearest building____Y_.��______________ 1_ Priv � Distance from nearest well________________________________________ _____ __-_..____ ❑ Distance to nearest lot line � ' ° b Remodeling and or repairing describe)------------------ !------------------------------_- -..------- ----- - ----- -- -------------------------- --- - -- -------- -----e__7-- - --------• -- -- - ------------------------- --- �---------------------------------------------------------------------------------------- =----------------- ------ 1 hereby certat I have prepared this application and that the work will be done in accordance with S`an Joaquin County ordinances, State laws, and rules and regulations Zf�fhSan Joaquin Local Health District. !l (Signed)----------- --� / -;------------------------------(��r Contractor) fBy'-- ------------------------------------------ ------------------.------------- �`�l (Title)--,� - =-------- ---------------------- (Plot plan, showing sae of lot, location of system in tela to wells, buildings, etc., can be placed on reverse side). k { - FOR DEPARTMENT USE ONLY !! -; 'APPLICATION ACCEPTED BY---- B, - --- - y DATE__I `` --y ---------------- ,Z, REVIEWEDBY-------------------------------------------- ------------------ ----------------------------------------------------------• DATE-------- -------- BUILDING -=` PERMIT ISSUED DATE -- Alterations and/or c ?t -- ---- i 1 !----------------------------- -------------------------I------------------------ ------------------------------------------------------------------------------------------------ ----------------------------- -------•-- ----------------------------------------•------------------------ ------- ------- --- -------------------------------------------------------------------- -------------- --------------------------------- - -------- -------------------- --------------------------------------------------------------------------------- -------------------------- ------------------------------- ---------------------- ---- - -- ---- FINAL INSPECTION BY:.- v Date----- C-� f �� SAN JOAQUIN LOCAL HEALTH DISTRICT 1801 E.Ka:elton Ave. 300 West Oak Street 124'Sycamore Street 205 West 9th Street Stockton,California Lodi,California x Manteca,California Tracy,California F.P.CL3. }