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FOR OFFICE USE: — -- - 4Y. ----------------------------- APPLICATION FORSANITATION PERMIT Permit No. . l lea. (Complete in Duplicate) ------------------ This Permit Expires 1 Year From Date Issued Date Issued1_� 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 LOCATION--- - 'D--:---C(---------��-5-i-------Ma 6/----- s C / '--- = s --L>,Erb !/1' �j � ..Z -/ Owner's Name__ / - C Phone `r-3C) y/ Address-- Contractor's Name---------- / -r-----------------------------------------------------•-------- ---- Phone----_------------ ... Installation will serve: Residence ❑ Apartment House F1 Commercial El Trailer Court E] Motel [I Other W Num '"- Number of living units:A_Qfh'4lumber of bedrooms -4____.. Number of baths -.7:_- Lot size -------AeR EJR__� _ - ----------------- Water Supply: Public system ❑ Community system ❑ Private X Depth to Water Table�•_,�Y? ft. Character of soil to a depth of 3 feef: Sand W Gravel ❑ Sandy Loam ❑ Clay Loam E] Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: IIf yes,date................... ) No New Construction: Yes ❑ No R---FHA/VA: Yes ❑ No M TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well-I( ----Distance from foundation__-_-/_____--------- Mete�ia€-- C}�- -T No. of compartments--------- ------------size--------/_ a ____:___Liquid de th_ yX - - - C--Capacity ----- Disposal Field: Distance from nearest well- Distance from foundation....l __......-Distance to nearest lot/line_____ ________ Number of lines_--..____/________ Length of each line_____ ---------------_Width of trench__.��_________-- -- Type of filter material___�___�._1 Depth of filter material------;W: ___......Total length_____' •_ -_ ------------•----- Seepage Pit: Distance fo nearest well------------- --------Distance from foundation___________________ Distance to nearest lot line-----.___..____._ ❑ Number of p�fs----------------------Lining material---------------- ---.Size: Diameter--- ------------------Depth------------------------------- I Cesspool: Distance from nearest well-----------------Distance from foundation------_------------_Lining material____..._._--_______._____-____..--._ ❑ Size: Diameter-------------------------------------- _- ----------------------------Liquid Capacity--.-------------------------gals, Privy: Distance from nearest well__.------------------____________________________Distance from nearest building---------------------------------------- ❑ Distance to nearest lot line----------------- Remodeling and/or repairing (describe):----------------------- - { ------------------------------------------ -------------- -------•------------------------------------------------------------------------------------------------------------------ { ------------------------------------------------------------------------------••----------------------------------•----------•-------------------------•------- ---------------------------------------------------------------------------------- -----------------•-•----------------------------------------•-------------------------------------------------------------------- I hereby certify fhat'l have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Stat yaws, and rules a 4 regulations of the San Joaquin Local Health District. (Signed,)------ ��-�. ----- . . 0 -------------------- (Owner and/or Contractor) I By:-----------------------------------------------------------------------------------------------------------------h------------------(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 k APPLICATION ACCEPTED/ ------------------------------------------------------------ DATE------- REVIEWED BY---- / --- ------------- DATE__.-.---------------- -- --------------- UILDING PERMIT ISSUED-------------------------------------------------------------------------------- --------------------- DATE Alterations and/or recommendations---------------------- ---------------------- ----------------------------------------------------•------------------------ - --------------------------------------------------------- i ------------------------ ------------- ---------------------------------------------------- ---------------------- ----•----------------------------------------------- ---------------- -------------------------------------------- --------------------- ------ ------------------------------ ------------------------------------------------------------------------------ --------------------------------- - ------- - - --------------- ---- --- ----- - ---------- -------------------------------------- F€NAL INSPECT ..-- -- - Date' ---------- --------- SAN JOAQUIN LOCAL HEALTH DISTRICT s 1601 E.Haxallon Ave. 300 West Oak Street 124 Sycamore Street 205 West•4th Street Stockton,California Lodi,California Manteca,California Tracy, California