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FOR OFFICE USE: "" -------------------------------------- --------------------_----------------------_------------- APPLICATION PDRIISANITATION PERMIT Permit No. ---- --- --------- ------------------------- --- -------- (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, JOB ADDRESS AND CATION-- - S�Ei17 � r��"s��-��` �- -- -•------------ Owner's Name__: r-. .- oV R - - ----------------- -------------------- Phone ------------------------------- )e- Address---------------� 6 Contractor's Name------0 0—RP--------------------------------------------------- ---------------------------------------•--- ----------------- Phone--------•-•.------------•---------- Installation will serve: Residence ❑ Apartment House E❑ Commercial (Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _ ---- Number of bedrooms -------- Number of baths -- Lot size _____,li _______________________ Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table _/5_ 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 iff"' New Construction: Yes ❑ FHA/VA: Yes ❑ No ©� TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic T nk: Distance from nearest well__ �1V-_-Distance from foundation-----�if�---------Material__CON!l No. of compartments----- --- ------Size_��__-K!_Q-X- ----__..Liquid depth__, --- --`---------------Capacity - _-- Dilllf._ sposal Field: Distance from nearest wel)_C. ..._Distance from foundation----ffl----------Distance to nearest lot E line --------------- Number of lines________ _ r ..____...___ __-Length of each line__� _ ________ea_ -__Width of trench_______ Type of filter mate rial___� _ Depth of filter material____-_�_7______._Total length________.__�'52�_-__ 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----------------- from foundation___---------------___Lining material_____---.._.___.______-____._______ ❑ Size: Diameter---------------'----------------------Depth----------------------------------------- -------Liquid Capacity----------------------------gals. a Privy: Distance from nearest well-------------------------------------------- Distance from nearest building----------------------------- ------- _.. ❑ Distance to nearest lot line---------------------- -------' S w.r. D I n/- aar► ------F_-QI------ ----------------- -----•---------------------------------------U_6 e�-D--------puA-l-N�----N&Rv QST-----S F- °^---- ani��-- ----- -------------------------------------------------------------------- ---------------------=------------------------------ - ---------------------------------------------------------•---------------------------------------------- I hereby cert' that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances. St �ws, and rule nd regulations of the San Joaquin Local Health District. I (Signed) F �C---- ---------- _(Owner and/or Contractor) By:------------------------------------•-•--------------------------------------------------------------------------------------------(Title)-- ------------------ ------------ --- .(Plot -(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 7 APPLICATION ACCEPTED BY-....... �Qt------------------------------- ---------------------------------------- DATE----- -----—17—A61 •--------------------- REVIEWEDBY------------------------- ------------------------------------------------------------ -------------------------------------- DATE BUILDINGPERMIT ISSUED------------------------------------------------------- --------------------------------------------- DATE--------------------------------- --------------------' Alterations and/or recommendations:-------------------------------------------- -----•-•- ------------------------------•-----•--------------------------------•--- ------ I ------------------------- -------- - ----------------------------- FINAL INSPECT "-- - - ---• '---- ---------- ---- -- - Date-- ---------- --- 1 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.C O. P