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W . FOR OFFICE USE: ` ---------------------- �z APPLICATION FOR SANITATION PIERMIT Permit No. .... ................ = =-----------------------I----- : (Complete in Duplicate)- qq� This Permit Expires 1 Year From Date Issued Date Issued _-/_--__XI-y .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. I JOB ADDRESS AND L CATION-- -,/.; - ---------------------------------------------------------------------------------------- JJ/JJPhone - .Owner's Name----------- ------------- Address........ --------------------------------•-•-----•----------------------- ._.. Contractors Name Phone Installation Ft, will serve: Residence ®Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ q ., Number of living units: I.. Number of bedrooms _J--- Number of baths Z--- Lot size�� - ------------_-__----__-_-..--.-- Water Supply: Public system ❑ Community system [�rivate ❑ Depth to Water Table 067 ft. 5 Character of soil to a depth of 3.feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe lardpan ❑ Previous Application Made: (If yes,date--------------------] No New Construction: Yes [B�o ❑ FHA/VA: Yes [—No ❑ TYPE OF INSTALLATION AND"SPECIFICATIONS: - (No septic tank or cesspoA, ermitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest w ---`-----_Distance from foundation---A1--`_--..Material--- I - -_- -.------._. No. of compartments- -----------------Size_ - � �iquid depth______',T .---.------._Capacity/ rd___- I 11 Disposal Field: Distance from nearest well-.---r77!7------Distance from foundation---- _ 40 Distance to nearest lot line--��_-.- �� Number of lines---------- - /Length of each line__��------ -- Width of trench,Z-_---_1------------------ Type o€ filter materiaL_ f� / Depth of filter material----A--.-.--=___-Total length-----/►��...----_---_-------- f Seepage Pit: Distance to nearest eIL --------------Distance from foundation---_1.�----- Dista�rice to nearest lot�clh a-- __---- Number of pits.---- ___- °•_ Lining mate ria l-_�6 -Size: Diameter-j—g-----------Deptn-,, Cesspool: Distance from nearest well -------Distance from foundation--------------------Lining material-------------.-----------------------. J i ❑ Size. Diameter----- ----------- --" Depth------------------------------ --------------------.-Liquid Capacity----------------------------gals. a Privy: Distance from nearest;well--.------- i_ ---------------------------------Distance from nearest bu;Jding----------------------------------------- , ❑ Distance-to-nearest-lot-line---------------------------------------------- ----------------•--_-"-- -------------------------------------------- -------- Remodeling and/or repairing (describe): �, " -------- -----------14� ----------•------•-------------- ----------------------------------------------------------------------- ------------------- ------------I------------------------------I----------------- ----------------------------------------------------------------------------------------------------------------------------------------------------------------------- -------------- - ------------------------------ V .---- ------------------------------------- -----------------------------Z-------------------- ��l hereby certify (that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. I (Sig`ned)--------------------- (�/or Contractor). { ` BY: Y-. _ --::^:--a_:--- (Title]- -_ (Plot plan, showing size of lot, location of system in re n to wells, buildings, etc.,can be placed on reverse side}. l FOR DEPARTMENT USE ONLY t APPLICATION ACCEPTED BY-.--- -- 1 = - -- --- --------------------------- DATE 1�Jc/ REVIEWED BY------------------------- -------------- --- - ---------------------- DATE BUILDINGPERMIT ISSUED-------------------------- -`----------------------------------------------------------------- DA•TE------------------------------ ----------------------------- Alterationsand/or recommendations:----------------------------------------------- ---------••--------------------------------------------------------------------------------------------------- _ f -- --•-•- ---•--------------- -- ------------------- --- Y - --- ,-- ----- psi _ - FINAL INSPECTION BY:..-.- ------- 004 -- Date----- - /Yi SAN JOAQUIN LOCAL\HEALTH DISTRICT i 1601 E.Hazelton Ave- 300 Wast Oak Street 724 Sycarnore.5+reel 205 West 9th Street Stockton,California Lodi;California Manteca,California Tracy,California F.P.CC.