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FPR OFFICE USE: ----------------------------------------------- -------- APPLICATION AOR SANITAT[ON PERMIT Permit No.I ' ------------------------------------------------------- (Complete in Duplicate) r�c5� Date Issued ------------ This Permit Expires 1 Year From 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. JOB ADDRESS AND LOCATION-------- ---------------------------- 1,7- f � Owner's Name ---- ••• - Phone_ ----------------------------------------- ----------------------- Address---------�3 -------- 7`171 C� n -.. ------------ -;AC. - Contractor's Name____ w " / l 4' - = ------ --------�--------- Phone Installation will serve: Residence ❑ Apartment House commercial [] Trailer Court Motel ❑ Other aw Number of living units: _1.___ Number of bedrooms ___-t Number of baths __ �p� ---- Lot size ------ --- ------------------- -•--------------- Water Supply: Public system ❑ Community system ❑ Private 4j--1�e_pth to Water Table Kr ft. Character of soil tQ a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ZI-11-ardpan ❑ Previous Application Made: (If yes,date....................) No,Z;_-'New Construction: Yes4a--_N__o ❑ FHA/VA: Yes ❑ No El- TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet,) Septic To& Distance from nearest well_ __Distance from�aund Material-_ .__ No. of compartments__________________________Size__.-Y_`%___X.>r__Liquid depth_._---_._- ._...___Capacity__ Disposal Field: Distance from nearest well_f-r---- Distance from foundation. _`__.Distance to nearest lot --- Number of lines------------------- - ------------Length of each line-------cam-- -_._.-------..Width of trench.--------__Z_ ------------------ Type of filter material___- t'�_ e Depth of filter material_...__ _.t ._-/.-.Total length_______: _ C___.,�'-__e^__.___- Seepage Pit: Distance to nearest well--------------___-----Distance from foundation--------.----------.Distance to nearest lot line-._-___-.__.._ )] Number of pits------------------ ---Lining material----------------------.Size: Diameter--------------........-Depth__----.__--------_-------------- Cesspool: Distance from nearest well_-__-_-----..__Distance from foundation--------------------Lining material-..._____________._.__________---_-_ ❑ Size: Diameter------------------ ---- ----- ----Depth_--------------------------- -------------- -----Liquid Capacity----------------------------gals. d Privy: Distance from nearest well---------- -------------------_------------------Distance from nearest building.__._..________________-_-_-------_.__. ❑ Distance to nearest lot line-------------------------- ------------------------------------------------------------------------------------------------------------------- Remodel* and/or repairing (describe :__..____._._ '��'�', �'t ��T~- _ __ - ` -- -------------------- -------- �CJ- g_�� ' ----i---- --� j�/t.�----- -- -`��C- -- ` 7- 3 , -----------------------------------------------------------------------------------------------------------------__------------------------------•-------------------- ---------------------------------------------------- i ------ I hereby certify that I have repared this application and that the work will be done in accordance with San Joaquin County ordinances, Stat and rt and egulafions�pf the San Joaquin Local Health District. f � (Signed] •--,----- (Owner and/or Contractor) •--------------------- r ----------i-------------------------- 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 APPLICATION ACCEPTED BY-------- ------ ----- ` 1= •----------------------- DATE.... _ _. �1 REVIEWED BYDATE ---------------------- ----------------------------- ------------------------- ------------------------------------------------------------ BUILDING PERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE----------------------------------------------------- ------- Alterations and/or recommendations:----------------- ----=--------------------------------------------------------------------------------------------------------•------------•----------------- FINAL INSPECTION BY:.-- -— Date -------------- ---------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Ho:elton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca, California Tracy,California