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FOR OFFICE USE: �- ------- --------- :? ------ ------------------------------------------- - APPLICATION FOR SAWATION PERMIT Permit No. .. . 1.g i --- ------------------------------- -- ---------------- {Complete in Duplicate} I _______________________________ _ ............_---------- 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 LOC TON_' ��3 -------------------------------- 1.// Owner's Name___ _ = ----- -------- Phone..-------------------------------- Address-----212-1---••---- -••------------•-----------------••-----------------•----------------------------------- -----------------•---•---••--••----••----•-•---------•-------------•--------- i Contractor's Name s' 7_S --- ---------------------------------- Phone Installation will serve: Residence ?!r Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __ i<___ Number of bedrooms _Z__ Number of baths __t__ Lot size S6� i. o--------------------------------------- Water ________________ __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 ❑ Previous Application Made: (If yes,date-----------,--------) No New Construction: Yes ❑ No e FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permifted if public sewer is available within 200 feet.) 1 Septi a� 7� Distance from nearest well-----------------Distance from foundation___________________Material-------------------------------- .____. No. of compartrnents--------------------------Size-----------------------•--------Liquidydepth----------- --------------Capacity----------------%----- Disposal Fi Distance from nearest well--- --.._____Distance from foundation_/a______________Distance to nearest lot line_-.-_.._-.- ❑ Number of lines____ ______�___ _______________Length of each line__'- Width of trench-At-l-'___`-------------------- { Type of filter material--- ./ __-___Depth of filter material-.f ----________._Total Glength----�_-�------------------------------ 1 Seepage Pit: Distance to nearest well----------------------Distance from foundation.....................Distance to nearest lot line_----.__-______ [) Number of pits----------------------Lining material----------.-----------Size: Diameter-----------------------Depth-------------------------------- 1 Cesspool: Distance from nearest well--------------_-Distance from foundation--------------------Lining material-__--_-_____-__________._______.___ ❑ Size: Diame'er----------------------- -----------Depth'---- ----------- _-_-.---------------Liquid Capacity------------------ ---------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building------------------------------............ ❑ Distance to nearest lot line------------------------ --- ---- ---- ----------------------------------------------------------------------- ---------------- I Remodeling and/or repairing (describe):---------------------------------------- ----------------------------•--------------•----------•------------------------------------- ---------- i t I , I --------------------------------------------- -------•-------------------------------------------------------------------------------- ----------------------------------------------------------------------- - ------------ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, a r es and reg do s of the San Joaquin Local Health District. (Signed)------------------ -------------------- -------------------------------------------------- --- --------------------------------(Owner and/or Contractor) gne ) By:---.----------------------------- -I------------------------------------------------------------------------ ------ --------(Title)------ ------------------------------------------- (Plot ----------------- ------------- ------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). 1 FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY kX_21�1DATE= - G REVIEWEDBY--------------------------------- --- - - ---------=-------------------------------- ------------------------------------- DATE-- ------------------•-------------------r--------- ----- BUILDINGPERMIT ISSUED-------------------------------------------------------------------------------------------------------- DATE----------------- ------------------------------------------- Alterations and/or recommendations:---------------------------------- ;I ------------------------------------- ------- ------•----------------------------------------------------------------------------- --------------------------------------•--------------------------------------------------- -----------------------------------------------•--------------------------------------------------- :----------------------- FINALINSPECTION BY:. ------ --------------- Date-- ------------------- ---------•---------- ------------------------------------ " SAN JOA Q -LOCAL HEALTH DISTRICT 1601 E.Hazellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9Th Street Stockton,California r Lodi,California Manteca,California Tracy,California F.P.C O. l