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f FOR FFICE USE: :? - - -- .. —• r r7 API'LICA710N` OR SANITATION PERM17 --------------------- --------- ------ Permit No. -..L. -�1.. G-- --__ ----- -- ---- -- ---- ------------------ .__. (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. ! r ---------••-----------------------•--•------------ JOB ADDRESS AND OCATI N--- -a-- ----- ----------- -- - �- Owner's Name------t4.-1 r'�/ l--- --------- Phone------------------------•--•-----•-- �/ / --•--•--- -------------------_------- Address---------------------------------- � - ---- ------ Phone----------------------------------- Contractor's Name / Installation will serve: Residence �iApartmenf House El Commercial E] Trailer Court E] Motel ❑ Other ❑ Number of living units: ---_,____ Number of bedroorn,�L , -- Number of baths _C-_-_ Lot size ____ A__ -------------------- Water Supply: Public system ❑ Community system ❑ Private [P-�Dpth to Water Table&"-'7 ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe EL,4-rardpan ❑ Previous Application Made: (If yes,date-----------.-------) No 2-'-New Construction: Yes ❑ No U5,-TTTA/VA: Yes ❑ No L;--, TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 204 feet.) Septic Tank: Distance from nearesf well-----------------Distance from foundation---.--------- Material__-._.-_._.______--_____________._-_- No. of compartments--------------------------Size---------------------------------Liquid depth----------- -- ----------Capacity-------------- -------- Disposal Fi Id: J Distance from nearest well./ i Distance from foundation---- --- V--------- istance to nearest lot line- --------. Length of each line___ .Width of trench._ Nu n6 of lines---------- a i of filter material-_-I_l_ ----Depth of materialJ-/f� Total length V /STS-✓L, �- Df ft p - ----------- o� g �--------------------�----i�- �.1 Seepage f Distance to nearest well__�BQ_.l_fi_._Distance oW undation__/4__�-____.Distance to nearest lot li e_aS-__-.- (� /,dumber of pits---_/--------------Lining material__ ---- Size: Diameter._ ____.__._ Depth_ _.- N�C--------. s�•a f� F e� ooi: Distance from nearest well-----------------Distance from foundation--------------------Lining material-------------------------------------- V ---------------- ❑ Size: Diameter-------------------------------- ------------------------ - Liquid Capacity-- -------------------------gals. • -----Dep}h ---- ----------------- Privy: Distance from nearest well-------------------------------------------------Distance from nearest building----------------------------------------- ElDistance to nearest lot line_--------------------- ---------------------- -------------------------------------------- ----------------------- • Remodeling and/or repairing (describe):------------- s ----------------------------------------- _, / �J7-- -- G ----------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------ 1 hereby certify that I have prepared this application and that the work-will be done in accordance with San Joaquin County ordinances, Sfat , and rules a ations of the San Joaquin Local Health District. --.._-.---_------------ ----(Owner and/or Contractor) (Signed)---.---- ---- B - -----•- --G-"----- ----------------------------- ------(Title)-- ----_------- (Plot --- ---------(Plot plan, showing size o , location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY.....� {-t------- ------------- --------------------------------------- --------- ----------------- I . REVIEWEDBY------------------------------------------------------------------------------------------------------------------------------ DATE ----------- ------------------------------------ BUILDINGPERMIT ISSUED------------------------------------------------------ ---------------------------------------------- DATE--------------------------------------------- ----------- -- Alterations and/or recommendations:-I_-:Z 'kt_�- ----L%4------ ------ --- S,Y -------- - �`- �� I - ---------------------------------------------- ------------ ------------•---------------------------------------------- ----------------------- ------------------.------------ ------------ ---------------------- -------- -- ------ ------- - ----------------------------- --- --------------------------------- ---------------------------- -- - - -----------------------11--- ----- ------------------------------------•----- ------------------------..-------------------------------------------------- ------------ --- FINAL INSPECTION BY:. ------------------ ------------ Date-----1 5---- ----------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy, California F.P.co.