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FOR OFFICE USE: r " //_ice_._----_" �� " APPLICATION s 'SANITATION PERMIT Permit No. .--��--�'� - ---------------" ------------------------ ------------ -------------- (Complete lin Dupiicate) Date Issued _____'-�.�'"�-• ----------------------- ------ ----------- This Permit Expires 1 Year From 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 A �CA Q l� � - -+ -----•--•--------------- ---------------•-------------------------------•------------ Owner's Name ------------------------------- ---------- 1 " Phone Address--------------------------- - -------------- Contractor's - - ----- t�. ��l�l� L� --. Phone .............. �-/ .... Contractor's Name--------------- - - 1"P-f 7 - Installation will serve: Residence �Ap/artmenf House F] Commercial Ll Trailer Court L] Mote! El Other ❑ Number of living units: __/ Number of bedrooms _: _. Number of baths --_ Lot size ----- Water -_Water Supply: Public system ❑ Community system ❑ Private [4/l5e_pth 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............._.-_.l No [ New Construction: Yes No ❑ FHA/VA: Yes E] No [:1 TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) f � �� on__ _.__ -Matena4 '" _--_-._- ______________�__ aSe tic Tank: Distance from nearest wel__,� - -_Distance from foundati No, of compartments_.'_-----------------Size_ _% Liquid de th �1 ----CpacifY � Disposal ,eld: Distance from nearest welt---6.4 _Distance from foundation--- ---------Distance to nearest lot line__---__-_ .� Number of lines---___x -----__.__ -"- -----Length of each IineG1/a_'___ _`_Width of trench._ ___r --______________ Type of filter materiaLS-r_AC_[f'----Depth of filter material___.,//!?...____._Total length Seepage 't-: Distance to nearest�w1ell_,r4__Q_f_-.-__Distance f om foundation__a.Z)___-.___ Distance to nearest lot line_ .____-__-- Number of pits--------9_-.- "-----Lining material-- C1C- ------Size: Diameter--.�_3-.------"---- Depth-- -"a ------------------ Cesspool: Distance from nearest well-----------------Distance from foundation------------------- Lining material............................ _________. ❑ Size: Diameter---------------------- ------Depth--------------------------------------------------- Liquid Capacity----------------------------gals. Privy: Distance from nearest well ------------------------------------------------Distance from nearest building..........---------------------------.- t� ❑ Distance to nearest lot line - ------------------- - ------- ----------------------"--------------------- ------------ Remodeling and/or repairing (describel------------------------------------------------------••-•---------------------------------- ---•-------------------•------------------------------------ -----------------------------------"-------------------- ------------------------- -- ---------- ------------------------ ---------•------------------------------------------------------------------------ -----------------•-------------- - -- -------•----- - have----------------------------------------------------------------------------------------------------------------------------------------------------- I hereby that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, S laws, and rules and re lations of the San oaquin local Health District. I ------------ "- -- �- - --- ---------- (Signed) //.—�.. -� ----------------------- -------- --" -----.{ .caner and/or Contractor) -- Tttle _ r�- -- ------------------ - ---- - gY= (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 r APPLICATION[ ACCEPTED BY------------------- -- / F- -- ---------------------------- DATE------ /� � - 7 REVIEWEDBY------------------------- - DATE------------------------------------------ ------------ BUILDINGPERMIT ISSUED---------•----------------- --- --------------------------------------- ------------------ DATE-----------------------------------------------------___ -- Alterations and/or recommendations:-------------- --- ----------------------------------------------•---------------------------------------------- ----------------- � �_ FINAL INSPECTION BY:. ---.-�`r.. --------------------- Date. ----------- >��------------ ----- -------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Flasellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.Cd.