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�I�FG R OFFICE USE: 3,;-) --- -------- APPLICATION ,I^OR SANIfATIOf � �� Permit No. f _ � --------------------------- ---- ---- -- --- -------- (Complete in Duplicate) s" .._..._..__. _______________ This Permit Expires t Year From Date Issued Date Issued ---- - - - -- � 143 - /40 -2-1. Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application ide in compliance with County Ordinance No. 549. w: s,ma - - -� - ---- ` -fi r ' JOB ADDRESS AND LOCATIO __ ___-___ _ _ ________ .---------------- Owner's --_-. = -Owner's Name---- yr±.t.1 .._...� Phone------------------------------------ Address � ��--------- ------- Contractor's Name--. �-------`--.--��------ ------ ------ Phone----------------------------------- Installation -----------------------•----- -Installation will serve: Residence ®--Apartment House ❑ Commercial ❑ Trailer Court ❑ryry Motel L] Other El Number of living units: _-�---- Number of bedrooms _.L-Number of baths _1---- Lot size ---97 _____X_`5_----x Water Supply: Public system ❑ Community system ❑ Private [Depth to Water Table _�ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ 1. Previous Application Made: (If yes,date-----------_--------1 No New Construction: Yes ❑ No HA/VA: Yes ❑ No [•4 TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septi a Distance from nearest well_________________Distance from foundation--------------------Material------------------------------------------------- No. .._____....______--_____ __.__________._______-No. of compartments---------------------- Size-------------------------------Liquid depth---------------- ---- ---Capacity---------------------- Disposal Fi I Distance from nearest well__. ____-_-Distance from foundation---7U--------.-_Distance to Nearest lot line______._.I Number of lines - -------------Length of each line__Za0._R_____-_-_-______Width of frenchZ.f_�______,_____..._____Type of filter material__2C?5-�--------Depth of Cfer�material---I-ak'- .---Total length-----/ +'- ----------------------Seepage Pit: Distance to nearest well-_____________________Distance from=foundation________________--_ Distance to nearest lot line_.________.___ ❑ Number of pits----------------------Lining material----------------------.Size: Diameter---------------.....-_ Dept h------------------------------ Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material------------------------------------- F1 Size: Diameter,.-- -------- -_......Depth----------------------------------------------------Liquid Capacity------------------ --------gals. Privy: Distance from nearest well-------------------------------------------.---._Distance from nearest building____._-___.__.____.__________.___.._.____. ❑ Distance to nearest lot I'ine-------------------=-------------- --------------------------•------ -------------------------------------------------------------------- Remodeling and/or repairing (describe)------------------------------------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------•....... I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Sta7r�� s, and rules and regulations of the San Joaquin Local Health District. _.__._Owner and or Contractor(Signed}------------ ------ --------------------------�------------------------------------------ ---- -- � / } 1 IBy:----------------------------------- ------._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 - I APPLICATION ACCEPTED BY - -- `- - - - ----------- ------------------------------------ ------------ DATE `31 REVIEWED BY-------------------------- ------------ ----- -------------------------------------------------------------------------------- DATE--------------- -------------- ----------------------------- BUILDING PERMIT ISSUED--------------------- - ----------------------- ---- - DATE----------------------- --- y� - Alterations and/or recommendations:------r..wk�+P�p_ __-___�i_-V77�- ._-___ �___ _ --D-- --------------------------------- -- -----------•---------- --------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------- --------------------------------------------- ...............--------------------- ----------- ------------- ---------------------------------------------------------------------------------- FINAL INSPECTION BY:--etV ----- - Date_.... _ ._ SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California r.P.CO.