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FOR OFFICE USE: APPLICATION FOR ft SANItATION PERMIT Permit No. --------------------------------------------------------- 1�C (.... ------- -- -------------- ------------------------------ (Complete in Duplicate) ____.______-- This Permit Expires 1 Year From Date Issued Date Issued �_l _ $"� 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. 724- "r=• = `"1 r 6 , - y� JOB ADDRESS AND LOCATION.._--.� -- -- - ------ - -1�---'�-v---�----------------------------Fr------------------ ------- ----- - Owner's Name---- --------- --dl ,--- ---�------------------------ ------ --------------------------------------------------- Phone---V -17�f- Address------, e •.. a ----f ---------------------- --------- -------------------------------------- ------ % Contractor's Name----------------- -------------------•-------•--------- ------ ------ ------ =—Y-!l= ___ Phone__ � _.;3�Z..�---- Installation will serve: Residence N Apartment ouse ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ 1 .: Number of living units: _/._ Number of bedrooms__- Number of baths -sr ._ Lot size _, i7---------------------------- -------------- Water Supply: Public system ❑ Community system ❑ Private ;K- Depth to Water Table'/ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam C❑ Clay ❑ Adobe X Hardpan ❑ Previous Application Made: (If yes,date--------------------] No New Construction: Yes 0 No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: f (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest we€I__SC------Distance from foundation-/O__ ___....Material_ ________________`�-- No. of compartments__-�-__.__...____`__-Size_��I�-�-��___Liquid depth_.;�_______----------Capacity_/,�_U_�-_____ Disposal Field: Distance from nearest well-_4. ......Distance from foundation---o7_©-_--_.�-Distance to nearest lot line_j_ ___�____ r� 1Z Number of lines_____z�_________ ._---Length of each line._lQ-�!_'__ !1_._.Width of french_____-P75___ --------------- Type ______________ � Type of filter materia]__!;�. ct'F----- of filter material__A ------------ length_________/.S-G_______________-- F i Seepage Pit: Distance to nearest well__/DO---------Distanc pm foundation_ .3_s_.._.___.Distance to nearest lot line.-.S___._____ Number'of its-. _Linin material_ Q.S._ ___.Size: Diameter.__. __...___.___Depfh_..._ _______________ P g Cesspool: Distance from nearest well-----------------Distance from foundation ------------------Lining material------------------------------------- ❑ Size: Diameter----------------- -- ---- -----------Depth--------------------------------------------------:_Liquid Capacity-------------------------•--gals_ w Privy: Distance from nearest well_____________________________________ Distance from nearest building---------------------------------- [� Distance to nearest lot Iirie----------------- - -- ---------------------------------------------- --------------------------------------------------------------------- Remodelingand/or repairing (describe)-------------------------------------- ---- ----------------------------------------------------------------------------------------------------------- ---- ----- ----- �-- --- --------------------------------- ----------------------- -- ----------------•------------ -------- - ------------- -------------- -- ------------------------------------------------ I hereby certify that I have prepared this application andthat the work will be done in accordance with San Joaquin County ordinances, S to laws�dru 11 and gulations of the San Joaquin Local Health District. ------- ------------------------------------(Owner and/or Contractor) (Signed)----------------- By:--------- ---•-- ------By:---------•----------------------------•----•----------- t1 - --------- --------(Title)__. ' ------------ ------------ (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 ACCEPTED BY_____, __ DATE-----/�,,�i _-�s-- ---------------------------- APPLICATION _. r---------- REVIEWEDBY--------------------------------------------- ---- --------------- ----------------------------------------------------------• DATE------------------------- --------------•------•------- BUILDINGPERMIT ISSUED-------------------------------------------------------------------------------------------------.... DATE_------------------------------------------- ----------- Alterationsand/or recommendations:---------------�-------- -- ---- ----- ------------------------ ---------------------------- ---------- -------------•------•-----------•------..------ ---•---------------- ------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------- --------------------------------- -- --------------•-------•--------------------- ------ -------------------------------•-------------------------------------------------------------- -------- -------------.__._------------------------------------- [_/.�1+1..._._.___._4-____ __�_//Jn_------_.__.._.____-___.[_'_�_______--_----_____...______-_._._______.-__.,.__-_____-._._...-____.__._.__.___..___..--______ k FINALINSPECTION BY------- ----- ------------------------------ -------------------- Date--------------------- - ----- ------------------------------------------------- N SAN JOAQUIN LOCAL HEALTH DISTRICT a 1601 E.Hazellon Ave, 300 West Oak Street 124 Sycamore Street 205 West 9th Street R ` Stockton,California Lodi, California Manteca,California Tracy,California F.R 60,