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-------._ yF ROFFICE USE: � .� --------Aa-hrn, APPLICATION FOK� SANITATION PERMIT Permit No. R----:5-.---_-- _3 ---------------------------- --------- ------------------ (Complete in Duplicate) ----------------------- This Permit Expires 1 Year From Date Issued bate 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. 4 CATION (JOB ADDRESS A,!7 5 ------- --- - - ---- --- - Owner's Name--- ----------- -------- ----- ------------ ---------------- - ------------ Phone----------------------------------- Address.......... _ --- ------------- ----- Contractor's Name_____________________ ___ _ t ---- -—-------------------- -------------- Phone - lr� -7. Installation will serve: Residence Apartment House ❑ Commercial A, Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -------- Number of bedrooms -------- Number of baths -------- Lot size -------3 -_—_.--____-____--_ Water Supply: Public system$1 Community system ❑ Private ❑ Depth to Water Table &S- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adober Hardpan ❑ Previous Application Made: (If yes,date--------- ----------1 No NZ New Construction: Yes ❑ NoVI FHA/VA: Yes E] No TYPE OF INSTALLATION AND SPECIFICATIONS: w (No septic tank or cesspool permitted if public sewer is available within 200 feet.) \ Septic Tank: Distance from nearest well-----------------Distance from foundation--------------------Material______________-.___-____--.____._______-_--.-_-_. [�\ ❑ No, of compartments- ------------------------Size--------------------------------Liquid depth--------------- ----------Capacity----------------------- Disposal Field: Distance from nearest well-----------------Distance from fcundafion--------------------Distance to nearest lot line----------------- El Number of Iines---•-------------------------------Length of each line---------------------------_-.Width of french----------------------------------- Type of filter material-------------------------Depth of filter material-----------------------Total length_____.____.__________...__-------_-____--_ Seepage Pit: Distance to nearest well./ 0AJQ__-__Distance rom undation_MI._---------Dist�n�c�e to nearest lot line.-S�--_____- j`��'/� Number of pits-Q3'i..f0....Lining material__ _Size: Diameter---_.__--_�j_-_-__.-----Dept h---2_47__________________ 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---------------------------------- --------- ------------------------------------------------------------------------------------------------ Remodeling and/or repairing (describe):_ ---------------------------•--••---- - -------------------- -- --------.�.� � � � - ---------------- - - ------ ---------------- --- --------------- hereby certify that I h p ared this application and that the work will be done in accordance with San Joaquin County or 'nances, State laws, and ru s and regulati s of the San Joaq ' Local Health District. (Signed)------------------------ - ---- -- - --- ..---- --- - -(Owner apd or Contractor) By---------------------- `-- �CaI1 > ---- - -- ---- Title)-- (Plot -- (rtle} (Plot plan, showing size of of, I�of system in relation to wells, buildings, etc., can be place on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-- ------ ----------e ------------------------- --------------------------------------- DATE-----------L� �� REVIEWEDBY------------ ------- - - --- - -------------------------------- --- DATE-------- --------- BUILDING PERMIT ISSUED--------------------- --- ---- --- --------• - DATE--------------------------------------------- --------------- Alterations and/or recommendations:._.____ N-. -.-------------------------------------------------------------------------- - ------------------------------------------------------------------------------------ ---------------------- ----------------------------- ---------------------------------------%- -- ------- ------------•---- -------- ----------------- -----------------------------------------------------------------------I----------- --------------------------------- FINAL INSPECTION BY:.---- -- ` --t/u• -"`.�-------------- Date-------��------ - ---------�- -------------- - - ---------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1801 E.1laselton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.C C.