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FOR OFFICE USE: ------------------------------------ �y t -----------A----------- ------------ Al-v.-ICATION FOlk SANITATION PERtv,.., 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 LO��C��A,,T_�ION. a (> -g -----•�T----- ��% Owner's Name---------------->21 ��/ � Address--------------------8TO--- ---------------71-e �. -Contractor's Name----- (!. F_ c�— :� va.7---- - ---- - � _ Ill Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel X Other ❑ Number of living uni+s:/4,/_ Number of bedrooms/.,4/ Number of baths //,p/Lot size -----------------------------------_---------------_________ Water Supply: Public system ❑ Community system ❑ Privates, Depth to Water Table ------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobek Hardpan ❑ I Previous Application Made: (If yes,date--------- ----------) No X New Construction: Yes ❑ No FHA/VA: 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 weU_________________Distance from foundation--------------------t Material_____.-._________.._-__ --__________-_____.--___. No. of compartments---- - -- Size--------------------------------Liquid depth------------- - - - Ca acitY----------------------- Disposal Field: Distance from nearest well_.CO--_A-_ ..._.Distance from foundation----/Q----------Distance to nearest lot line__r-_,Or------ . Number of lines_______:'_________ _ _________Length of each line-------�4.o__.______-Width of trench._--_ .-!____ Type of filter material._ _- :.__Depth of filter material-__/,X-"'.......Total length-___---�d_` ______________ 0" *" ` Seepage Pit: Distance to nearest well__ ` _____ ___ i _ _ _ Distance to nearest lot line-__S----____ Number of pits---.=4-----------Lining;material___ ---- .Size: Diameter-- s - - ---------- Depth------�.�5„`------- ---- + Cesspool: Distance from nearest well-----------------Distance from foundation___ ----_--------- Lining material------------------------____--___--_ ❑ Size: Diameter--------------------------------------Depth----------_---------------------------------------Liquid Capacity-- -------------------------gals. Privy: Distance from nearest well________________________________ __-__Distance from nearest budding_----.--------------.--------------------- F1 ________- ___-_.❑ Distance to nearest lot line--------------------------------------- Remodeling and/or repairing (describes):---------------------•- ----- - -------------•-•----------------------------------------- ----------------- -----------------------------------------------------------------------I ---- -------------------------------------------------------------------------------- -------------------------------------------------- -------------------------------------------------------- ' - - ----------------- -------------------------------------------------------------------------------------------------- aD l ' I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County I ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. _(SignedgY�------------ ---- ----------- -------------------------------------------------------- �,1.�----------------------------------------.�-_______.-_{Title]------ ---------------(Owner and/or Contractor) (Plot plan, showing size of lot, location of sy to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED $Y - - DATE _14----------------- i REVIEWEDBY -----------"------------=------------------- ------------ ----- -------------------------- DATE p BUILDING PERMIT ISSUED------------- ----- i_-- ---------------- .... DATE DATE----------------------------------- f Alterations and/or recommendations:-----_5/' A - ---------------------------------------------------- ------------------------ j ..........E----------- ---------------------------------------------------------- ----------------------------------------------------------------------------------------------------------- ------------------------------- --------------_----------------------_------------ .----------............__--_-________.______._--_ __._____-____._____._.-_-_____._.-_____.-.__ ______ . _ ._____---_-_-_-.--__.-__-.-.--_____----_---__-____-___-___- _ r FINAL INSPECTION BY--------------------e ---e------L%-------------------- Dafie A SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E,Maxelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.C r].