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FOR OFFICE USE: -- ----------------------------------------------------- - - -- ---------- ---------- -------•- APPLICATION FOR - ------ -- $ANITATiON PERMIT Permit No. .. ... ----------------- ---- ------ Complefe-in Duplicate) --- --- This Permit Expires i Year,From Date Issued Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein descried. This application is.made in,com i nce with County Ordinance No. S49 I JOB ADDRESS_AND LOC ON._.�_7.. LA �- � �lA E'�/g`I�� QP . t Owner's Name------- j 1�-1_ `� -------------- - Phone------------------------------------- Address_------------ -•-----------------------------•---Address_______________ _ Contractors Name__-0 MlEi7----------------------- ------------------- -- •------- Phone ------ --------------------- ---•--------- Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer -Court Motel ❑ Other ❑ Number of living units3__._ tuber of bedrooms _4___ Number of baths__._ Lot size _��-E�-�_ — Water Supply: Public system E Community system ❑ Private F-] Depth to Water Table / _ ft I € Character of soil to a depth of 3 feet- Sand Gravel [] Sandy Loan) ❑ Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑1 Previous Application Mader (If yes,date---_-._-_.._..---- } No New Construction: Yes ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: - "" -(No`sepfic tank of cesspool permitfed if public sewer is available within 200 feet.) Septic T Distance from nearest well......fie '.._Distance from foundation___----1Q .MaterialDNC.I�� } __----._ No. of compartments-_-Z...----------Size_&r!7_X. _4------Liquid dCapacity.,g_��_ epth._..: ._ - �Q Disposal F' Id: Distance from nearest well-�_.0___--Distance from foundati n----f0-____._.Distance to nearest lot lin___,- Number of lines.----------1--------- ----------Length of each line-- __��---_ -�---..Width of french...--,,. _--- ------,r-----� �g Type of filter material--_ 0�' i_____Depth of filter materiaI_.__•_,e�__ __ Total length-------------- � to See�ge Pit: Distance pits rest welt=-----=-Lining maDteraalce from foundation Diarnete�_..Distance toDepthnearest lot line________________- 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 ____.____- _ i ❑ -------------------- Distance to nearest lot line ___ - - I Remodeling and/or repairing (describe):--------------------------------------------------------•- ---•-------------•------------- , ---------•-•------------------------=----------------•---------------- ---- T -------------------------------------------------------------------------------------------------------------•------- -------------------------------------- --------------------- ----------- ---------------- -- ------------------------------------------- -------------------------------------------------------- ------•--------------------------------------------------------------------------- . k I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County i € ordinances, State laws, a les and regulations of the n Joaquin Local Health District. y r (Signed) f 1 (Owner ..�J ,. .. . „ _ _ — ,� --�_ __ ---- Owne_rand/or Contractor) - -- _ By-------------------------------------------- - (Title) ...._ . . 1 m ----- -------- (Plot plan, showing size of lot, location of system in relation to wells, 6uildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-----------7_R_,O_•--------- --- --------------------------------- DATE._,_._. REVIEWED BY -------------------------- Q4� .-HRAR-.----- -------------= --------------------------- DATE------ =_7�..4 -1 BUILDING PERMIT ISSUED-------------------------------------------------------------— ----------------- DATE--- ----- Alterations and/or recommendations----------- .----------------- ------------------ ..._.____--___,---_ ----------------------------------------------------- ---------------------------------- - -------------------•----------------------- ------------------------------------------------------------------------------------------ ---•---- ------=-----•------------------ -------------- ------------------------ -- .......... -- ------I.... ------------ ------ ----- ------------------------------ ---------------- ---------------------- ------ ------------------ - - -------- ---- -- ---------- ------ ------------------------- - ------------ -- F€NAL INSPECTf :_ - - 1� Date.-.- ----- ------ SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Ha=elton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi, California Manteca,California Tracy,California E.H.9 2M 1-67 Vanguard Press x _