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FOR OFFICE USE: ----- ------------- ----------------------------------- APPLICATION F( RSANITATION PERMIT Permit No. -- -------------- - ---------- --- �` S ------.tC.__- �fi -- (Complete in Duplicate) Date Issued ---. __------------- This Permit Expires 1 Year From Date Issued _ ----------- Application ,s 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---- - T ,� _7 - - -- - _ W : _ _ —. -------- ------------- ----- Phon --- ./ -- ---- Owner's Name-- '�� = _. e i ` � �- 1: Address_ -- - ;, Contractor's Name-- ----- �_ Phone.._..-.. -• -- Installation will serve: Residence �partment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -_1--- Number of bedrooms 4�Number oaf-baths ---"_-_ Lot size _------- -------------------------------------------------- Water Supply: Publics stem ❑ Community system Private ®�epth to Water Table ._� ft. Y Y Y ❑ . Character of soil to a depth of 3 feet: Sand E)"-,Gravel ❑ Sandy Loam ❑'Clay Loam Clay ❑ Adobe❑ Hardpan C] Previous Application Made: (if yes,date-..----- .'- ---I No ©KNew Construction: Yes 2--"No FHA/VA: Yes ❑ No ❑ I TYPE.OF INSTALLATION AND SPECIFICATIONS: :E (No septic tank or,cesspool permitted if public sewer is available with200 feet.) Distance from foundat n f n-._...•Material_- --------- � Septic T nk: NoDistance compartments from eat welly _.-- .-_ yo / f ----fin-----Size-J)�e)f�fz� --Liquid depth---------A -CapacltY A Disposal Field: Distance from nearest wl�ef/ll'� Distance from foundation_--.f" ------.Distance to nearest lot li e-------------- ---------------- '7 g ;-6 =, �---Width of trench....---�� f-"------------- dupe of it lines----_ -_____,f__4_ ",Depth offilterlter mlater al----.-/" -----Total length._ -/ Type of filter mater3al_- 1 l 6„ Seepage .it: Distance to nearest well-/. ion_---�.(�----___.Distance to nearest lot line- _-__-.- Numbter of pits__--' ___ Liningmaterial .Distance from �o ndSie: Diameter-t _-Depth-..l~ • " - f Cesspool: Dista'ce-from'nearest"well___�---_--_---_Distance from foundation----"------------"_Llning material__-_--------------"-""_-_--_---"-- _❑ Size: Diameter-------------------- ~- -------' Depth-----------------*--- ----- ------------------ Liquid Capacity---------------------- ----gals. O Privy: Distance from nearest wellj-------------- -------------------------------Distance from nearest building----------------------------------------.- ❑ Distance to nearest lot line----- ----------------------- ------------------------------------------•------------------- ------ ------------------------------------ .�r Remodeling and/or repairing (describe) ---------------- -----------------------------------------------------------------------------------_.._------------------------------ Y ------�--------- - - •-- --------------------------- -------------------------------------"------------------------------------------.------ ------ --------------------"----------------- --------------------------------- ----------------- 1-------------"-------------- ---------------- -•-------------------------------------------------------------------__---------------------------- ------------------------ ------- I hereby certify hat I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Sta11, and rules and reguKfions/f th San Joaquin Local Health District. (Signed)-_ - ------------ (Owner and/or Contractor) --------------------------------------------------------------------Owner fan showing _r� il -----•---------------------- ----- -- g ------------(Title)------ --------------�------ -----------------( P g ` cation of system In relation to wells, buildings, etc., can be laced on reverse side). -FOR DEPARTMENT USE ONLY N Gr / APPLICATION ACCEPTED BY-------- .� ---- -- - =---------------------- DATE-----5 l am, ---'------------------- REVIEWEDBY----------------------------------------- ------ ----------------------------------------------------- DATE------------------------------------------------------------ ` BUILDING PERMIT ISSUED--------------------------------------- --------------.- DATE-.----------------------------------------------------------- „ Alterations and/or recommendations-------- ------- ---------------------------•-------------------------------•-----------------•------------------------------- -----------------------------------------------I------------------------------------------------------------------------•-----------•--- FINAL INSPECTION BY:...,& - C � ------ Date-----�"� _---- --- ------------------ AN JOAQUIN LOCAL HEALTH DISTRICT, 1601 E.Hazelton Ave.r 3 0 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California l Lodi,California y4 Manteca,California Tracy,California ES 9 REVfSE❑ 8-59 3M 3-'63 F.P.CC.