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FOR OFFICE USE: , c ti "" - _'S _--.�-�±-,__�"�. �APPL-�CATION FOR_ SANITATION PERMIT Permit 'No. -�7 (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. JOBADDRESS AND LOON ...---- ----------------------------------------------------- '�--------- ---•_-------------------------------- Owner's Name ' ---- -- G z` `"-------- one Address-------------/Zl ! r .------ --------- •------� _---------------------------------------------------------------•---------------•------------------- Contractor's Name.-...-. - Phonea -- ..r �- Installation will serve: Residence A Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _r(--- Number of bedrooms --A- Number of baths Lot size ----- -.j- - ----------------- Water Supply: Public system ❑ Community system K Private ❑ Depth to Wafer Table -------- ft. Character of soil to a depth of 3 feet: Sand W Gravel ❑ Sandy-Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date-- } No YL New Construction: Yes [K No ❑ FHA/VA: Yes ❑. No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic nk: Distance from nearest well. Distance fromoundz,tion.--_--------------Material--- ------ No. of compartments--------.--s --" -__Size__AX 0--.?f_ _..Liquid depth.......--.--_.------Capacity_./�W � f Disposal Field: Distance from nearest well.,{/[-".:Distance from foundation_.40/.......Distance to nearest lot line....'f._...._-. Number of lines----------..j--- ---------- -----Length of each line--------7-z!�'/i�-----Width of trench-------------------------- Type of filter material__ _Depth of filter material___.ft1~._....-----Total length_.___".,: :/_qV .....f.-- Seepa if: Distance to nearest well-X. "e-0istance from foundation------_t e-.- Distance to nearest lot line ...47.-.-.- Number of pits------/ ------------Lining material. ).- ..Size: Diameter..----17 --- Depth.. -._-...-.____._... Cesspool: Distance from nearest well-----------------Distance from foundation--..----------------Lining material-......- -------- -----.-.-.--__....- ❑ Size: Diameter--------------------------------- ----Depth------------------------ -------------------------Liquid Capacity---------------------------gals. Privy: Distance from nearest well------------- -----------------------------------Distance from nearest building-..-....-.._...----_--.--_---------..-_ ❑ Distance to nearest lot line----------------------------------------------------------------------------------------------------------- ------------------------------- Remode4ing and/or repairing (describe):--------------------- -----------------------------------------------------•---------------------------------------------------•-----•---------------- -----------------•----------------------- ------------------------------------------------------------------------------------------------------------------ --------- ----- --------------------------------------------- ----- ------------------------------ -------- ------------------------------------------------=-------------------------------------------------------•--------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County r ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. v ....... -- -------- ----- ------ - ----- ( / (Signed) Owner and/or Contractor) By:------------� - ----------j- ----------------------------------------------------------------(Title)--------------------------------------.-...... (Plot plan, showing size of lot, (ocatio of system in relation to wells, buildings, etc., can be placed on reverse side]. FOR DEPARTMENT USE ONLY ` APPLICATION ACCEPTED BY------ �. . ct ----------------------------------- DATE------------//---/.-.......� --------------------- REVIEWED ------------------ REVIEWEDBY-------------------------------- -------------------------------------------------------------------------------------- ----- DATE------ ----------------------- ----------------------------- ! BUILDING PERMIT ISSUED--------------------------------------------------------------_ ----- --- DATE---------------------------------------------------- Alterations --------------------------------- ----------------Alterations and/or recommendations:------ b =--- - G -' ` r - '��3 :.. � r-------I'2'=`=----�-- ' -------------� ---��.----- C� �Z l� = -------------------------------------------•--•--------------------- ----------------- ----------------==--------------------------------------•-----------•--------- ----------------- --------------------------------------------------------------------------------------------- I FINAL INSPECTION ------ BY: --- L ' ` ------- Date------- c------- -y� ..... .� SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Ha:eltan Ave. 300 West Oak Street .� 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California i F.F.CC. - ,