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FOR OFFICE USE: s <br /> ----- ---_______ -__------- --- ------_ ,/_t>zt-_ . ix APPLICATION FOR SANIT TION PERMIT Permit No. �z-.( ..-. <br /> --- ----- (Complete-in Duplicate) (ri <br /> Date Issued .__ <br /> -....---.-._-.-._-__._--_-._. This Permit Expires 1 Year From Date Issued <br /> .. __�___ <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> This application is made in compliance with County Ordinance No. 549. l <br /> JOB ADDRESS AND LOCATION-__,._2-.%.5._ 6---- ...... ..--- `I .C� <br /> Owner's Name.----- --- ---------- J_f����---T--�-�---1-.-d---t-----'-----�-�------- ------ � - Phone---- &--_:,Aa <br /> Addres -�s------�en-----------------0..........---- �- <br /> Contractor's Name.........0404!e'�----------------_------------------- -------- ------- ---------------------------------------------- Phone--" Ir...--------- <br /> Apartment House F] Commercial F] Trailer Court ❑ Motel E] Other E]Installation will serve: Residence [ <br /> Number of living units: __%____ Number of bedrooms _ _ Number of baths J_... Lot size __. __f✓- _� __---______________________ <br /> Water Supply: Public system Dj' Community system ❑ Private ❑ Depth to Water Table ---- . ft <br /> Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ AdobeX Hardpan ❑ <br /> Previous Application Made: (If yes,date-_.---------.------ ) No New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest well___----`5.0_---Distance from foundation_.-_� ..-___Material_y_.Lt���.�F___- -__. <br /> No. of compartments____ j--_--.._.Size-----3_*2T5_X ._,___Liquid depth--- _!J- --_-__.Capacity...... <br /> Disposal Field: Distance from nearest ►yell.---��_--.-Distance from foundation----/6._-----._.Distance to nearest lot line .__...__. <br /> Number of lines ........�,------.-.-------------Length of each line__ ._ ,,Q------------------Width of trench-------- <br /> ----------�-_-______---. <br /> Type of filter mater�idl__` � =�._--Depth of filter material---- ------------Total length______.. _ �_---__-_--_-_--___ <br /> Seepage Pit: Distance to nearest well----------------------Distance from foundation---------------..-_.Distance to nearest lot line------........... <br /> ❑ Number of pits--- -----'__.__-...__.Lining material---------------------- Size: Diameter__.._._-_-_-___-.-__Depth__-.--._-.__-_-_-____.--___- <br /> Cesspool: Distance from nearest well ---------------,.Distance from foundation--_............. ..Lining material_-_.._---.-_----_.-_-_________--__ <br /> ❑ Size: Diameter- -------- - -- ----------------Depth------- -------------------------- -----------------Liquid Capacity---------------------------gals. <br /> Priv Distance from nearest well-------------------------------------------------Distance from nearest building N <br /> ❑ Distance to nearest lot line------------------------ ------- -----------•---------------•--------------------------- <br /> Remodelingand/or repairing (describe):--------------------_ ---------------------------------------------------------------------- ------------------------------------------------------- <br /> ----------------------------------------------------------------------------­----------­----------------------------------------------------- --•---••--- ------------------•----------•------------------------------- <br /> ------------------ -----------------------------------------------------------------------------------------•--------.------------------------•-------------------------------------•- <br /> ---- -------------------- ----------------- ------------------------ -•-------------- -------------------------------------------------------------------------------- ----------- <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. <br /> (Signed)----- ------------------------------------ <br /> ------------------------------------------- ---------------------(Owner and/or Contractor) <br /> By- <br /> l .t _ �Y' (Title)_ <br /> Y• - -------------- ------------------------------------ - - - - <br /> (Plot plan, showing size of lot, Ictolon of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEP RTMENT USE ONLY <br /> APPLICATION ACCEPTED BY_ -- --- ------------------------------------ DATE------- -ra. <br /> - -------------------------- <br /> REVIEWEDBY--------------------------------------------- --------------- ---------- ---------------------•--------------------------- DATE------------------ -- <br /> BUILDINGPERMIT ISSUED--------------------------------------------------------------------------------------------------- DATE----------------------------- -- <br /> Alterations and/or recomme tions:_-----------------_-__....____---_- ------_.._. _-.__.-___-_-_- <br /> ...- X^^ - l.._ ----------- -------------- ------------------------------------------ <br /> ----to <br /> ----------- ...................... --------- -------- ----------------------------------- ----------------------------------------------------------------------------- ---- ----------------- -------- <br /> ----------------- --------- ----------------------------- ---------------- -------.-.------------------------------------------------------------------------------------------------ -------------------------- <br /> FINAL INSPECTION BY, , ^_ -!!_La ------------_ ------ Date...... ' = �---- ---7---� - - - <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Wa:etton Ave. 300 West Oak Street -- 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi, California Manteca,California <br /> Tracy,California <br /> E.H.9 2M 1.67 Vanguard Press <br />