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FOR OFFICE USE: ------------------------ -- ---------=------------------- ',APPLICATION - ------ ',APPLICATION FOR ,SANITATION PERMIT Permit No. - ------------------------ ----------------- (Complete in Duplicate) This Permit Expires 1 Year From Date Issued 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. f?i 1 0 JOB ADDRESS AND LOCA/TION--- �7 C, D' -- -`--I � .1/'-- '- _� �_�_L� _�-f_01"Aa,. Owner's Name--- -----_---=-------If,44y-----F�-,2-ow.//`t1�0 aw----------=--------------- - -- -------- ---------------------------.-. Phone------------------------------------- r"_1Address------------ 1 L=--- -r2 �� fl C---------- < ------------�------- Contractor's Name---------- - -'�'_---------- r .L `= _ Phone Installation will serve: Residence ❑ lApartment House ❑ Commercial (] Trailer Court ❑ Motel ❑ Other p'_11,5HOT- Number of living units: _—_ _ Number of bedrooms __-- Number of baths __� Lot size ------- :C �--------------------- Water Supply: Public system ❑ Community system ❑ Private Er---Dpth to Water Table /.Z-ft. Character of soil to a depth of 3 feet: Sand ' Gravel ❑ - Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan [] t Previous Application Made: (If yes,date--------------------) No 2-"New Construction: Yes ` `CoElFHA/VA: Yes ❑ No Q� TYPE OF INSTALLATION-AND-SPECIFICATIONS:.- - - - - (No septic tank or cesspool permitted if public sewer is available within 200 feet.) 7�1 ° Septic T nk: Distance from nearest well--- ._-_. ----Distance from'foun'-a-tionM"_ _ ..__. T_- -_-____ _. No. of compartments.-_____%�____--.---Size Liquid depth_.', Capacity -------- --- �(/3 Disposal Field: Distance from nearest well Distance from foundation._..j_�_�__--------Distance to nearest lot line j Ejl'- Number of lines---!______-__/-__________________"Length of each line__-_--s. Q.-._«'_....Width of trench.___�� _ ___._-..�.___-.. Type of filter material--- of filter materiai____./�--__-.----Total length_______________- ___._ ----- Seepage Pit: Distance to nearest well.-__--_-------------Distance from foundation--------.-----------Distance to nearest lot line-.-_.--_- -_..._ � ❑, Number of pits.--:'----------------Lining material-----------------------Size- Diameter-...-------------------Depth--------------------------------- Cesspool: Distance from nearest well-----------------Distance from foundation-----.-------------lining material------------------------------------- ❑ Size: Diameter-----I = - - --- - Depth--------------------- --------- - ------------ ---Liquid Capacity- --------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building---------- --_-.___.__________..___--.-_. ❑ Distance to nearest lot line-------------------- t Remodeling and/or repairing (describe):-------------- ---------------------------=-': -----------------------------------•-------------------------------------------- -------- I II 4 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, andrules nd regulations of the San Joaquin Local Health District. ; (Signed) ----- - --------------- �_— ------- --------(Owner-and/or Contractor) -,,t Tale (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). + FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------- ------------------------- ----------------------- DATE 1 -------------------------------- REVIEWED =REVIEWED BY------------------------------------------------ ------------------------------------------------------------------ DATE----- ---------------------------------------------------- BUILDINGPERMIT ISSUED------------------------------------------- ---------------------------------------------------------- DATE-------------------------- ---- ----------------------------- Alterations and/or recommendations-------- - -------------------------------- - -----------•---------------------------------------------------------------------------------------------------- a i ---------------------------------'------------------------......------- ---- 1 -- ________________________----------•------------------------ __.__.._______..._--.- ___________________________________ _____e- -----. _. .____- ______..__________.._--- - ---------------- -------------- - ---- --------- - -� ......-, ----- - - - ----------------- � � FINAL INSPECTFQN BY:. ----% . ...... 7? Date----- - -- ------ ------- ------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1401 E.Hazelton Ave. 300 West-Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California r — Manteca,California Tracy,California F.P.1;D. .