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R OFFICE USE. �G ------------------------------------- -------- --------- APPLICATION FOR SANIT TION PERMIT Permit No. ___ _ ---- -------------- (Complete in Duplicate) �� _____________ This Permit�Ezpires 1 Year From Date Issued Date Issued ___.. ____ ____�___ ---- ----------•- --......--- cl �# Application is hereby made to the San Joaquin Local Health District for a permit to can ruc and install the work herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION----_ cS - :_s ,, .. ._----- -- -- -- --- --- -- Owner's Name---------��-1��!-n------------Ar,� -------------- ---------------- -------------------------------- ----------- Phone------------------------------------ Address ---------Z -- p vr.�-Y -• ------------------------------•---------------•---------------------------------------------------------------- t Phone.!%._'—/=__2-1j 6 ContractorsName------ f'-------------- ------- --------------------------------------•------------•---- Installa+ion will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court rt ❑ Motel ❑ Other ❑ Wig.v" Number of living units: __----- Number of bedrooms ____-.- Number of baths __L---- Lot size _----------�z o-r f--------------------• Water Supply: Public system ❑ Community system ❑ Private a Depth to Water Table ___`1-- ft. ��- Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy,Loam ❑ -Clay Loam ❑ Clay ❑ *eiebe ® Hardpan ❑ , Previous Application Made: (If yes,date---------------------) No Ej New Construction: Yes [� SNo ❑ FHA/VA: Yes ❑ No [E- TYPE OF INSTALLATION AND SPECIFICATIONS: ! (No septic tank 9-r cesspool-permitted if public sewer is available within 200 fee+.}' t � Septic-Tank: Distance from nearest wek_X1..........Distance from foundation_._1a-r__._. -.Material/�rc GAS ----- - [�- No. of com "rt' --"'-- -----Liquid depth-------'%_-------------.Capacity.-ZV.`/ --- Disposal Field: Distance from nearest well..s'w°_1------Distance from foundation___!°-_-_-.._.__Distance to nearest lot line------------------ H Number of lines__.------------------------_Length of each line/Eo-! z?_s�4 `C`_� idth of french........4_,--_-----_____-_----_ . - it � T e of filter material---�+�6.4_k_._... Depth of filter material----`-------------Total length------3.7 5____________._-._-------- Seepage ___--._ See a e Pit: Di5.ance to nearest well_-________________'.Distance from foundation Diamet--__Distance to nearest lot line____-_-.----_---- � P 5 Number of pits------- --------------Lining material---------- ---- - --------Depth-------- -------------------- Cesspool:} iE from nearest wel! _ _______Distance; from fou ndation_.._...._._______..L' ia __._____.....-._--__.___.____.______. 1(� 67 ❑ Siie: Diameter------- -- - --------------------Liquid Capacity-- --------------- ----- c ---- -gals. -------.Depth Privy: Distance from nearest wel.--------------- ---._.- __--------------Distance from nearest building--- O Y� Distanceto nearest 1 -_x ------------------- ------------------------------- ------------------------------------------------------------------------------------------------ Remodeiing and/or re wring �describej - - - ---------------------------- a • -------------------------------------------------------------------------------------------------------- -------------------------------------------------------------------=---------------------------•-----------•--•-------------------------------------------------------------------------------------------I------------ r { I hereby certify that I have prepa-red this application and that the work will be done in`'-accordance.with'San Joaquin County ordinances, State laws, d rules an'd regulations of the n Joaquin Local Health District. r '` (Signed) �------------------- (Owner and/or Contractor) € Title By.---------;2��__-__---y._-_._.-___----..__-.--_--..._-.--_-_----___._________________________.__.___._( )__._....______._.___...____.__..___._.__._._..._...____________ (Plot plan, showing size of lot, location of system in relation +o wells,•buildings, etc., can be placed on reverse side). - __ .. . . .-�., FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY.._ _ -�-`----- ---------------------------------- -------------- ---- DATE------7_--_�r------------------------- REVIEWEDBY------------------------ --------- -- -----------:------- -------- - DATE-------- ---- ------------------------------------- ---- BUILDINGPERMIT ISSUED---------=--------------------------------i------------------------------------------------------------ DATE------------------------------------------------------------- Alterations and/or recommendations:-------------- --- ------------------------- - -----------------------------------------�------------------------------------•-----------------•------------- ' --------------------------------------------------------------------------------------•----------------------------------------- _,---;-_ .. -._ - -_- — ------- ----------------- -- --------------------------------------------------- -------------------------------------------------------------------- -- --- •------•--- x r 1 FINAL INSPECTION BY..._ --- - ----- Date-- --- --1= T---� - = --------------------------- ------- �- - -- ------------------- 3�7.- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California