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FOR OFFICE USE: ( 6i x APPLICATION_.FOR,:iANITATION PERMIT# •.. Per ---- ------ ----------------------------- (Complete in Duplicate) Date Issued - - l./ _------------------ This Permit Expires 1 Year from m Date Issued " Application is hereby made to the San Joaquin Local Health District for a permit to s n install the work herein described. This application is made in compliance With County Ordinance No. 549. 141 . JOB ADDRESS AND LOCATION-- ____�--------------- �-�- c-O ---- Phone Owner's Name---------------- - - - ------ -----------• ----� -- -----..-�---•-•--------a ------------ - I I Addressd�° *- -------- --------- Contractor's Name--------------- - . ----------------------------•------ ---------------- Phone-- --•---------------- Installation will serve: Residence F1Apartment House [I Commercial ❑ Trailer Court ❑ Motel El Other Number of living units: ------- Number of bedrooms -------- Number of bathsop5f --'a-----, Water Supply: Public systemCommunity system [IPrivate E] Depth to Water Table yt. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam [] "Clay ❑ Adobe Hardpan ❑ Previous Application Made: (if yes,date-,--------- .---) No New ConstrucfionttYes [g.-No FHA/VA: Yes ❑ No E] TYPE OF INSTALLATION AND SPECIFICATIONS: ; (No septic tank or cesspool permitted if public sewer is available within 200 feet.)I (� Septic Tank: Distance from nearest weIlDistance from_foundation--l-d----------Material----- . _- _-------------------- P� i r �- No. of compartments---------�----- ----Size-�//A�(�--Y-�:---Liquid depth:-._--�----------------Capacity --�.�-�-�-r�----•- -Disposal eld: Distance from nearest well _Distance from foundation-- -:--.Distance to nearest lot line--- ---------- r Number of lines___._p�--___----- s --=--------Length of each -------- -----.Width of trench- �.�------------------------ -----Tota1 len of filter material- -1-. lE.G� ___Depth of filter materia..... ------ length 4-Q-----.-. Seepage it: Distance to nearest well - ___Dista nce fo ndation--- -_ 7 -------- Distance to nearest lot line-------------------- Number of pits-----/------------Lining material---- .Size: Diameter--.� �.�--- ----Dep th-----------�`��----- ---- . • 3 ,Cesspool: Distance from nearest well-----------------Distance from foundation.-----------.-------Lining materials--...-..----------.-----.---------- ❑ Size: Diameter----------------- ---------- - -------Depth----------------------------------- q Capacity----------------------------gals. Priv Distance from nearest well--------------_.-.-- - ----------------------Distance from nearestlbuidangeit _:____=_-�_T�=_ ❑ Distance to nearest lot line-------- ------ ------------------------------------------------------------------ ---- ----------------------• -- - ---- --- ------------------- r Remodeling and/or repairing (describe):------ _-__.__._------ ------ --- - -- J� '�` `,� ----------------------•-----------------------•---------------------------------------- --------------------- -------------------------- 1 hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, tate laws,, and rules an regulations of the San Joaquin Local Health District. {Signed) ----- -------------------------------- -------------- By: ------------(Owner and/or Contractor) i By:--------------------------- ---- "` ------ ---------- {Title) ------------- Is, ----------- ... - t (Plot plan, showing size of lot, location of system. relation to wells, buildings, etc., can be plated a reverse side). FOR DEPARTMENT USE ONLY / : I APPLICATION.ACCEPTED BY- L - DATE �� ¢ REVIEWED BY------ ---- - DATE I BUILDING PERMIT ISSUED-----------------------------------------------------------------_-----------iT- ----a-------------- ATE------------------------------;---------------------------- Alteratio and/or recommendations:------ -- ------------- r-- - - ------- ----------- - — j --------- I : FINAL INSPECTION BY:.---------�------- `e-x---'�� ------ Date--------- -- �- ----------- V SAN JOAQUIN LOCAL HEALTH DISTRICT 1801 E.Hazelton Ave. 30o West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California r i F..P.qq- 1