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f FOR OFFICE USE: �� a I _.. ------------------------------------------------- j' p I -------------- APPLICATION FOF!ANITATION PERMIT Permit No. ------------------------------ - ------ (Complete in Duplicate) Date Issued ---------------------------------------------------------- This Permit Ex fres 1 Year From Date Issued '4j" 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. I JOB ADDRESS AND LOCATIO '_,._/Y�/ --��''.L�_x�2:...�vE��-_tel Owner's Name---------- _ ____ Phone._ l_-- _ . Address------------------------ f �r .._. !? -------- - / Contractor's Name-------------- '-�--�--- -=-----r------- -----� �.1��1------- _�..?/�,�5_..,.�.1✓�. Phone__��_��-- Installation will serve: Residence �Aparement House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __f___ Number of bedrooms ___3 Number of baths/�/VLot size '_________________________ I Water Supply: Public system ❑ Community system ❑ Private Z Depth to Water Table ........ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam Ifl Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (if yes,date--------------------) No [A New Construction: Yes ❑-No ❑ FHA/VA: Yes F' No ❑ 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____7..-�_____Distance from foundation_____.._._Material_--� '�` ____________________. [!� No. of compartments_._-__''�- -_----- ---------Liquid depth--. _�'______ Capacity-/�',010 l'4', I'-- tea i Disposal Field: Distance from nearest well 75�,__.___._Distance from foundation_-�-��___.------Distanc r�to��earest lot line_-------------- ❑t w� Number of lines______A Length of each lin �' ' �-�-�------- --------- 9 �-l--��---,�P.W idth of trench---�=-�f--.�------------------ Type of:filter material- Depth of filter material___ )'___ _--- Total length___yz fJ --------------------- Seepage __________________Seepage Pit: Distance to nearest well_/-474_--------Distance fr 'm foundation__/��---.___ Distance to nearest lot iine_a� _--___ FAB of pits---__ _-----------Lining material__ f. -.Size: Diamefer._ _� .".._-._Depth_--.,;_2:. -------------- Cesspool: Distance from nearest well-----------------Distance from foundation---_---------------.Lining I _ ' - -- --- material-___-___----._.-------------_-______ ❑ Size-.'Diarneter`�":."-_ ----�--"------..--Depth-------------------�-----------____________________Li Liquid Capacity----------------------------gals . - Privy: Distance from nearest well--------------------------__--------------------_-Distance from nearest building....-.-_-----.----_-_-______-_.-_------ ❑ Distance fo nearest lot line-------------- --------------------- o Remodeling and/or � repairing (describe:-._.�-.- --� ---` s ��j--------•------------------------------ --------------------------------------------- - --•------------------------•------- -------------------------------------•------ --------------- --------------------------------- ------- ------------------------- -------------------------- -------•---------- ----------•---•---------------------------------------------------------------------------- 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, "and..'rules and regulations of the San Joaquin Loc 91balth District. _____Owner and/or Contractor) (Signed) h--------- /.]1,5------------------ By:---------�= -7 = =' :;._ -- --------------------------- -(Tit e ----- -- --- - -------- 01 } (Plot plan, showing size of lot, lot on 1 f s eiil in"relation to wells; liuildirigs, etc.;c n'be placed on reverse side). .� 4,.r.1 *� FOR DEPARTMENT USE ONLY I APPLICATION ACCEPTED BY -------- =------------ DATE_---�>R- 5 �` - REVIEWEDBY ---------------------------------------------------------------------------------------------- DATE--------- -----•----------- ---------------------------- BUILDING PERMIT ISSUED ------------------------------------------------------- - ---------- ----- DATE-------------------- ; Alterations and/os recommendations------------------------------- ----------------- -----•-••------------------------------------------------------------------ ------------------------------ --------------------------------------------------------------------------- ----- ----------- ----- ------Jt------------------------------------------------------------I--------------------------------------------- � ` `3---------------------------------------------------- ---------------------------------------------------------•---------- ------------------------------------------------------ ----------------------------- ------------ -------------- ----------------------------•-------- F FINAL INSPECTION BY-----A2300 ---------------------------------- Date > __"" -_ti._- N JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave, West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California N R Manteca,California Tracy,California F.RCU.