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FOR OFFICE USE: Q L Permit No. ---.•�•- -- APPLICATION FOR 5"ANITATION PERMIT --- --------------------- I [Complete in Duplicate) ,. .Date Issued .'��-�•� ---------------------- - - This'permif-Fi i-' - 1'Yt3ar roin D`ate'lssued ----- ---------------- ----------- 1. r.. Application is hereby made'to the San Joaquin Local Hdeallth Dist inance NoC549 a permit to construct and install the work herein described. Thisapplicatio is=mike in compliance with County — . ' - p � % ----------------------------- -----------•--------------------------------- --- JOB ADDRESS AND LOCATION --- ------- Phone-------------------•---------------- •►"-fir p---- --- -------- - --------------------------- ------ ------ ----- ---- ----•----------------- Owner's Name------ ------ � - --------------- •--- / / r Address---- - Phone e�� `r: S Z 7 Contractor's Name------- �-`----- "� � o me Other Installation will serve: FResidence [- Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ ❑ Number of living units: -1----- Number of bedrooms Number of +thfio W-- Lot size -- ----- ft. Water Supply: Publics stem 0- Community system ❑ Private ❑ P Adobe 0— Hardpan ❑ 5' PP Y� y Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑FHA/VA: Yes ❑ No [� Previous Application Made: (if yes,dote--------------------) No ® New Construction: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: - ` [No septic tank or cesspool permitted if public sewer is available within 200 feet.] wQ n- r f ' Septic Tank: Distance from nearest well--.ft --Distance from foundation__._. a---------.Material_____-..�--- r 9 r -- -----Ca acct �'9-`� - . No. of compartments...___.-------- -------Size__3__XS_x._.•.-----.Ligwd depth__.__'L---- --- - P Y-- Ig ' Width of trench-_-.-Z--�---------------- Disposal Field: Distance from nearest well -.h/_o--- ..Distance from foundation-__l' ___.__.._.Distance to nearest lootine_________________ Number of lines--------- --- - - Length of each line___..-'-T -"ry� Total length------ �'S---------•------- --------- C_--_.-De Depth of filter ma 19---- Type of filter materWa ....4Qc- p I { A Seepage Pit:` !Distance to nearest well----/1��-----------Distance from foundation_'1_p_�__-._--.Distance t.. nearest lot line- ------------- ' h . °�-�----.size: Diameter._.3�-'.�-- --.Depth - --Zs- ---•------------- Number -�------- -- Number of pits._.-_�-------------Lining material- _�.-.-- =Distance from nearest well ___.__Distance from founda}ion....................Lining material ---------- gals. Cesspool: Liquid Capacity -----------•-•-- 9 ❑ :Size: er--° ----- ----- --------- ::--Depth ------ --------------- -- ----------- - ----Distance from nearest building---------------- - Privy: Distance from nearest we ------ ----------------------- ----- -------------- ❑ Distance to nearest lot ine------------------------ , 1 ------------------------------------- ----- ------ ---- ----------•-------------•----------•-------__. Remodeling and/or repairing (describe):_-.-_------------ t i h�° ''i H�� F`r------------------------ --- ------- --- - ------------ -- F --- ------------- ------ ------------- i ------------------------------- ---------- --- - ---- ------- -- ----------------------------------------------- ---------------------------------------------------a—t will - o l I hereby certify that-.I-have_p epared ths oll the San Joaquin Local kHealth eDi}rlctn accordance with San Joaquin County ordinances, State law , and rules and regulations [ and/or Contract Q -11 Owner a d�o or) (Signed) - It --- - -- - ---------------------------- ----------- ---[Title}------------------ ------- BY:-------------- t -- i [Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). I r F R DEPARTMENT USE ONLY ------ DATE-- APPLICATION ACCEPTED ----- - ------------------- ---- DATE------ ------- - -------------------------------------- -- REVIEWEDBY---- ------ ----------------------------------- ------- ------•- ----- ----- ---- p TE-------- ------- BUILDING PERMIT ISSUED---------------- - Alterations and/or recommendations:___--.-_-.-- t ------------------------------- - --------------- ------------- •-------- --- ------------- - ----------------- ------- - ------------------------ -- - ---- - -- Date L .._. -- --- -- -- - -- ------ ----- ._ �-�"------� FINAL INSPECTION BY: _..--- ��f --- ------ 4 SAN JOAQUIN LOCAL HEALTH DISTRICT 124 Sycamore Street 205 West 91h Street 1601 E.maselton Ave. 300 West Oak Street s. ^ Manteca,California � Tracy,California Stockton,California Lodi,California ,i F.P.Co.