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FOR OFFICE USE: s �.. I ) r s_ / l ------------------- 7 �--� - - Permit No. 1 x i_ ____. APPLICATICtFRSANITATION PERMIT` e ----------- ----- - ----------------- '(Complete in Duplicate) _ _ ,.® 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 AND LOCATION- -- f ��1 -:_ ; _s Owner's Name. .- af' ---------VvW --------------------------------------- ----- ---------- -------------------------- Phone---------------------------•-------- i Address ----- ; s:,.: ----------------------------------- Contractor's Name ��i s-.!-------------------------------------------------------------------------- ---------------- Phone------------------- -----••-----•-- } Installation will serve: Residence [ p'rtment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _/-_ Number-of bedroomsr -._ Number of baths _ Lot size ._,ay.- 't� _"a�.............._-....__-_--_..- Water Supply: Public system E] Commun°ty system ❑ Private �epth to Water Table _/ ft. Character of soil to a depth of 3 feet: Sand,❑ Gravel ❑ Sandy Loam ❑ Clay Loam �ay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (lf yes,date_-_ ------------) No ®®' New Construction: Yes g?O'ldo ❑ FHA/VA: Yes �o ❑ Ilk TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) pp � Septic Tank: Distance from nearest well 4-P----- Distance om foundation__, .---Mater'aI , _.. p�- No. of compartments_.___. --_ Size e - _ -----Liquid depth__ � ._._Capacity/94? ----- Disposal ----- Dis osal Field: Distance from nearestwell _ _-P _.._Distance from foundation../e�--..Distance to nearest lo� pNumber of lines_ -_, �4;_ _ ._. ength of each line_,� e Width of trench.�r.._. f ------ ---- Type of filter material. __' � epth of filter material- ------- Type length_ .........:. .. s Seepage Pit: Distance to nearest well_. &-_...Distance fr m fo dation...- --- ..__ ice to nearest lot I�e_4---- .- --- Number of pits_- . _._--.__-__Lining material. . -Size: Diameter- --------Deptho�.- / 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-----------_--------------------------- Distance .__._.......:...........Distance to nearest lot line---------- ----------------`---------------------------------------- ----------- ----------------- ---------------------------- E Remodeling and/or repairing (describe): __- '"''"`"" ; — •------`---------------------------------•---------------------- - ----- - - ---- ------ ------------------------------------------------------ ----- i --- -- ------------- --- ------- ------------------------------ -•=- --------------------- --• ------- - •--•----.------------- - - ------- - _ - ---- ------ ---- - -- -- ----- ------------------------------I------------------- ------;----------------------------- �-- 4 1, I hereby certify that I have prepared this application.andFthat�the work will be done in accordance`with San`Joaquin County i ordinances, State laws, and rules and regulations oftthe San Joaqu' Local Health District. ' - - - ------------------ -- - - , (Signed)----------------------------------------------------- � or Contractor) B -------------------------------- (Plot ' -:--.-(Title)---- - - Y:--------------------------------------- ------------ ------ ---- - ! (Plot plan, showing size of lot, location of system,in re n to wells, buildings, etc.,,can'be:placed-on reverses de). i FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY - - e :._ -------------------------=------ DATE �1 Y REVIEWEDBY ` ------------------------------------------ DATE........ . ------------------------------------------------- BUILDINGPERMIT ISSUED----------------- -----------------------------------=-------- ---- -----------------;---- DATE-------------------------------------------- ----------- 1 ' Alterations and/or recommendations:....-.._1. , �_�� _._.i ------------:_?-----::f ' -----I�`¢"=-"-- =- a. __ :. -- ... -_ - . FINAL INSPECTION BY: - - - �i-��i----- - Date----- l --------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT' 1601 E.Hazelton Ave. 300 West Oak Streei,• "124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California