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-------------------------------------------------------- APPLICATION rJ SANITATION PERMIT Permit No. ------------------- --------- ------- --------- ------- - (Complete-in Duplicate) .r - . ---------- -- This Permit Expires 1 Year From Date Issued Date Issued .__71? G_.;' 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'��-.9.. / ice /7�./ f�,.? GwT0 .. Owner's Name------ -� .h/ �T - - Phone__ .3.f--/..�1 _.__. Address-------------_-------- Contractor's Name---- 1J7 - �'---------•----------------------------•--- Phone_W_d__`�V��-_- Installation will serve: Residence X Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _1___- Number of bedrooms _3.. Number of baths_ __ Lot size __� X � --------------------- Water Supply: Public system ❑ Community system ❑ Private to Depth to Water Table 70- ft Character of soil to a depth of 3 feet- Sand ❑ Gravel [] Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe OU Hardpan ❑ Previous Application Made: (If yes,dote-------- --........ ) No X New Construction: Yes ❑ Nog FHANA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well_________________Distance from foundation.._----------- -----Material . No. of compartments.----------- ------------Size-------------------- ---- - ---Liquid dep!th.--- ---- ------ -------- Capacity----------------------- DisplFeld: Distance from nearest well-.70 Distance from foundation_._ � .r�-(�"--_____.Distance to nearest lot lin!�i�-..__... ❑ Number of lines d?-_��jj1� ____._N.-Length of each line-_ ___'7t$" _._.Width of french...... .y_--.- __---.-- Type of filter materialfrf /--�__.__Depth of filter material--------- -��-_Total length______.__-7;:1>- __ ______________ Seepage Pit: Distance to nearest well_ ---------------Distance from foundation-------------------.Distance to nearest lot line__.__.____.---___ ❑ Number of pits--- ------------------Lining material--------- - ------- Size: Diameter------r---------------Depth--------- - --------------- Cesspool: Distance from nearest weff --------- ------Distance from foundation.....------------ ..Lining material---------------------------- --------- ❑ Size: Diameter Depth - ----- --------------_-Liquid Capacity---------------------------gals. .� Privy: Distance from nearest well.-----_-----------------------------------------Distance from nearest building ❑ Distance to nearest lot line-------___----- _-.-.-.---_------__- Remodeling and/or repairing (clescribe):_____ 4W_ 44_.�------- �D ----- ------------------------------------------------------------------------------- •-------------------- ------------------------------------------------------------------------------------------ -------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Sta�ws, and rules end regulations of the San Joaquin Local Health District. (Signed)_____________ __R �cSH--__� a�s_._-_-.----___--- [Owner and/o Contractor) ------ -- -- - -- ------- ---- ----- By:. •--------- ----- ------(Title) --�i spM c, of pan, 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_____ _ _ -�- '---� ---------------- ------- - DATE--------- REVIEWEDBY----------------------------------- ------ - ----- ------------------------------------------------------ ------------ ----- DATE--.--- --- BUILDING PERMIT ISSUED-------- -- ------- ----------------------------------------------------- ------------ --------- DATE Alterations and/or recommendations:---------------------- -------------- - - -----------•--------- ------------------------------------------------------ - ------ --------------- ---------------- --------- ---- --------------------- � _' 7 FINAL INSPECTION BY:--Iv-------------------` 1r --------- ------------ Date----/--0 ----------- ----L SAN JOAQUIN LOCAL HEALTH DISTRICT 1 601 E.Mazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th street Stockton,California Lodi, California Manteca,California Tracy,California E.H.9 2M 1.67 Vanguard Press (�