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-------------------------- --------- ---------------- - ------------------------ -------------------------------- APPLICATION FOR ANITATION PERMIT Permit No. --- --------------------- ------------- ------------ (Complete 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 i }a wor erein desc ed. This application is made in compliance with County Ordinance No. 549, / �y JOB ADDRESS AND CATION_- - s Owner's Name , fes ` 7. ---------- Owner's ------�-I-- -------- y4 Address = ,: Phone-------- Contractor's Name----- - l�- --------Racl` ----• • - -•-------•-•--- one Installation will serve: Residence lb --•---• - •-❑ q �he❑ Apartment House ❑ Commercial ❑ Trailer Court l Mo e Number of living units: --,�_ Number of bedrooms �--.. Number of baths �-_ Lot size -�F 1r --------------------" Water Su Publics stem Supply: y ❑ Community system ❑ Private Depth to Water Table/A- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam W Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date---------- ---) No ®"' New Construction.- Yes TrNo ❑ FHANA: Yes ❑ No � TYPE OF INSTALLATION AND SPECIFICATIONS: '� ��r[No septic tank or Cesspool pe mitted'ifJublic saver is avadabfe within 200 feet:]; r , Septic k: Distance from nearest well �y Distanrompunda ion__ D �" --- ----------- No. of compartments------------ --Srz � -.�` --Li uid de th-_"i_># _ _Ca y Liquid P. f . . --- pant --1 Q_ Disposal Field: Distance from nearest wel!_/A%7___Distance from foundation---fr ........Distance to nearest lot line-a�-_.....---� Number of lines_------/"-- Length of each line- 40-l0-- -" Width of trench-.A,___- ----------- ____ Type of filter material�� -----.__""-""-` $- e. .--Depth of filter material- --- ---Total length--,&--&#&*-------------------------- 41 Seepage Pit: Distance to nearest well---------------------- from foundation----.___---_----_--.Distance to nearest lot line------------------ ❑ Number of pits---!---------------- Lining material------ ---..___------__ ize: . SDiameter----------------- ----Depth_................................ 0 Cesspool: Distance from nearest - "arest well-------------- --------------- -----Distance from foundation material--..__....-----.----._ ----------- - p �+ ❑ Size: Diameter----11---------------- ----------Depth----•---------- - ---------- ----- ---------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well------------------ ------------------------------Distance from nearest buildin' g- .----------------------------- -------- ❑ Distance to nearest lot line- ------------------------------------------ ----------------------------------------------------------------- Remodeling and/or repairing (describe):-------- fi�V__, — . � ----------- -----•-------------------------------------------------------------- - -------------------------- - •---------- ------- --------------------------------------------------------------•--------------------------------------------------------------------------------------------------------------•------`-------------------_---..-------- I 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 regul ions of the San Joaquin Local Health District. i� (Signed] � r -- ) { ------------------------------ --- in ---------------------------------------------- n roc or r A02 - ----------------- [Title]___-- (Piot plan, showing size of lot, location of system ' elation to wells, buildings, etc., can be placed on reverse side). s i t FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------ -R'_O-. DATE--------- - REVIEWED BY ------- ------- ------------ ------------------------ --- --- DATE ------------------------------ BUILDING PERMIT ISSUED-------------- -- ------------ ---- ------------------------------------------------- DATE--------------------------- ---------------- -------------------------------- Alterations and/or recommendations:_-"--"-.- ------ - ---------------------•------ ---------------------------- ----------------------- - ------------------ ---------------------------------------------------- ------------------------------------------------------------------- -------- - - ------------------------------------------------ ------------------------------ --------------------------- FINAL INSPEC -----;--- -- - - --- Date------------------- -r /�..-_------------ -------••--- j SAN JOAQUIN LOCAL HEALTH DISTRICT 1401 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi, California Manteca,California Tracy,California F.P.0 a.