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FOR OFFICE USE: ' � �--- r. - Permit No. ..-(..� APPLICATION, FOR SANITATION PERMIT S.(Complete in Duplicate) Da}e Issued - ]� This Permit Expires 1 Year From Date Issued f 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-_-- -7-3-/------------ ` ---------- / Phone�Z_s -"- 1-----Z_ Owner's Name%------�. l" -�;$4. a------��--------`-�-�------------- -4�P�G q Address-------• � ------------------- ---------------------------------------- 46� ! 6 Q 5. rve,.- ---------- Phone- -------_ ------------- Contractor's Name---- ------��-�---�.��-�<+e-�-I�-�------•-- - - --------------------------------- Installation will serve: Residence, Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ - ------- - -e-------------------------- Number of living units:-" Number of bedrooms 2--Number of baths -------- Lot size --"- Water Supply: Public system ElCommunity system [IPrivate K Depth to Water Table-Q- ft. Character of'soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam X Clay ❑ Adobe ❑ Hardpan ❑ Previous Ap lication Made: (if yes,date---.-------:___.-- -) No New Construction: Yes ❑ No� FHA/VA: Yes ❑ NOA i TYPE OF INSTALLATION AND SPECIFICATIONS:`< (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: J Distance from nearest well -----Distance from foundation"-.-----------------Material--- ---------------------------------------------- No. of compartments---------- - ---Size---------------------------------Liquid depth--------- ac ------ ---------Capity.. !-- PLO ❑ ---- Distance to nearest lot line-- ----__-_---. Disposal Field: Distance from nearest well- 47Distance from foundation.--""..-- Number o4 lines----- - ---------- Length of each line--- " 2= .__Width of trench..4 2-4-1----------------- Total len th-------- �� / Type of filter material-- _ [�1 -Depth of filter materia� �- 9 y -.---.Distance to nearest lot line-"` ---`--- See a ePit: Distance to nearest Well.- 400_ Distance from foundation___ r Number of pits. �...- g Depth _--.-"Linin material _&Rize: Diameter.--r" _-_ -..Lining material-- --------------------------- ----- -------------------g----- Cesspool: .: Distance from ne est well---"-------------Dis#ante from foundation---.-.-.-...____- "gals. Size: Diameter.... ---------- -Depth--------- ---- -------------- ----------------------Liquid Capacity---------------------- y Distance Priv Distfro nearest well----- -..- -------------------------------------Distance from nearest building...--------__-.------------------------- ..tn2,S _ ❑ , Distance to neares# lot line----------------------- ------------- -�� ----- ------------------------- -- ------------------- ---- -------------- ------------ ------------- ------- 1-- ---- -- r . Remodeling and/or repairing`(describe):._-_ --.--- - 1 �-rtey ---------------------------- --------------------------------------------------------------------------------------------------------------------- -------------------------------------= - ------------------------ I hereby certify that I have preparedAis application and that the work will be done in accordance with San Joaquin aunty ordinances, State laws, and"rules and regulations of the San Joaquin Local Health District. -----------F`-------—'-- ----- - --------(O per and/or Contractor) - ------------(Title) --- - ---- By:---------------------------- -- ---- --- ---------------- ------------------ (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 S ' �- . APPLICATION ACCEPTED BY---, --�'--� --� ---------- - -- DATE--- -------�•5----------- ---------------- .. REVIEWEDBY-------------------------- ------- ------------------ -------- ---------------------- DATE lBUILDING PERMIT ISSUED--------------------------------- --------------- DATE------------------------------ --------------------------- Alteratiorfs and/or rec mmendations:------ __� � -------------------------------------------------------- - ------------------------ •----- - -------------• .. / T .,� ! 'x r ----------------- -------------- -------------- FINAL INSPECTION BY: -. ---4 -. -- -- -------- -- --------- Date-__-.-- `:"./-.2-.-----�o.�-� -------------------------------- AN 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.CO.