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FOR OFFICE USE: (f 14 /O ( -------------------- ---------- - ---------- -----.------------- APPLICATION FOR 6ANITIATION PERMIT Permit o. --------------------------------- --- -------------- (Complete in Duplicate) E Date Issued __-._------------------- ..------------.__.__-_--- This Permit,Ex fres 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. z"w This application is made in compliance with County Ordinance No. 549. { JOB ADDRESS AND OCATION----•-tZ/5----.-.ft` xw_e4 --z_w-.' 4- -------- ATW. : --------- ------ Owner's Name------------- ----------�- tJ_F—�---°-----..._-.- ---------------- - ------- ----- Phone----•-------•----------------------- t _________________ _ _ ..........RRMIS[.0 N --------D ------l�T-cA__- ------------------------------------------ Address Contractor's ----------•------------- ------------------ Phone----------------------------------- Installation will serve: Residence Fr—"'Apartment House 0 Commercial ❑ Trailer Court ❑ Motel ❑ Other El r O Number of living units: ----[p-'_ Number of beds--_ room ___. Number of baths:--/--- Lot size ----.,Aae r),- ��!-.-_-___------ ----------•-------- Water Supply: Public system-�ommunity system ❑ Private ❑ Depth to Water Table C3 ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑,Sandy Loam [Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous.Application Made: (If yes,date-_-----------------) No New Construction: Yes No ❑- FHA/VA: Yes 2�" No ❑. TY.PF'OF-INSTALLATION-AND SPECIFICATIONS:._ (No septic tank or cesspool permitted if public sewer s�available within 200 feet:) f / - Fit.- I.� Sep"fict'knk: Distance from nearest well---4—_-Distance from foundation-_-1-0----._ Mai ed I_.. Ql1l _�_ . No. of,compartments._.__ Size-'_ ,/ /Z7:-x 5._ _Liquid depth____-. __ ___..Capacity.._ f r -- - w r Disposal-yield: Distance from nearest well---CW.-Distance from foundation-_-1p._.---_:Distance to nearest lot line7r Number of lines____ _____ ________ _________Leng h of each Jine_4�-6-6-' .Width of french._.---.-_ .--.j.--------- x Type of filter materiaL_R.V.C�.---Depth of filter materia!_`.j__ __` Total length_____________ ��i___'--_---__-___ yp I , p❑gr it: Distance to nearest we11------- ._.---Distance from foundation------------------- Distance to nearest lot line--_-..----- See a e,P Number of pits---------------------Lining material-----------------------Size: Diameter------- ---------------Depth---..-.--------_-----------_----- 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-_------------------------------------- I ' Distanceto nearest lot line.....'- ------------------ -------------------------------------------- --------------------------------------------------------------------- Remodeling and/or repairing (describe):---------- •--------------------- - ------------------------------------------------------ -----------------------•-------- -----------------------•-------------------------------•------------------------------------------------------------------------------ --------------------- --- ---------------- -- - --- -------- - - --------------------- --------------------------------------------------- ------- ---------------------------- -------------------- I hereby cer * that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinance$, e.law , an s a tions of the San Joaquin Local Health District. A - .(Owner and/or Contractor) (Signed)------ -- -� = --------------------------- By:By: --------------------------------------------------------------------- -------------------------------------------------------------(Title)------------------------ --- -- ----------- -- --------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMEMf USE ONLY APPLICATION ACCEPTED BY --------------------- --------------------------------------- DATE------ C--21.___4 6------------------- iREVIEWED BY----- --------=------------------- ---- -------------------------------- .------- DATE--------- ------------ --------------------------------- BUILDINGPERMIT ISSUED------------- ---- -------------------------------------------------------------------- - DATE---------------------------- - ------------------------------ Alterations and/or recommendations ------------------ ----------------------------------------------------------•--------- -------------•--`---------------------------------- ------ --------------------------- - --------------------------------- -----------------------------------------------------------------------------•---------- ---------- -------------------------------------------•----- --------------------.- ------ FINAL INSPECTION BY:._1L�.1-- ------ Date....-_ _ .. �'.{�._ .. SAN JOAQUIN LOCAL HEALTH DISTRICT r 1601 E.Hazeltan Ave.' 300 West Oak Street r— 124 Sycamore Street 205 West 9th Street k' Stockton,California Lodi,California Manteca,California Tracy,California . 7