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FOR OFFICE USE: ------------------------------------- _----------------------, , __---/.'- �- APPLICATION F&rSANITATION PERMIT Permit No. __00�15 --- -_ ----------------------- ---- (Complefe•in Duplicate) ------------.--- This Permit Expires 1 Year From Date Issued Date Issued Application is hereby made to the San Joaquin local Health District for a permit to construct a install the work herein described. This application is made in compliance with County Ordinan No. 549. r JOB ADDRESS AND LOCATION- _ - f/-- --- -� W--- -- ----------------------------------- Owner's Name------------ ----------------------------- ---- Phone f Address---------------•-------•----•-- •---------------- ------------_------ -------------•---------------------------- Contractor`s Name--- 'f- __� - __ ------ - - --- -- - -�� ----=---- - -�`-+------- --- Phone will serve: Residence Apartment House ❑-- Commercial'❑ Trailer vCourt [] Motel ❑ Other ❑ Number of living units: __�___ Number of bedrooms____ Number of baths../---- Lot size��sf-f.�.. -,��J'��._.�.-_.__ 1 Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table ______ _ ft Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ardpan ❑^ Previous Application Made: (If yes,date------------------- ] No ❑ New Construction: Yes ❑ No FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer'is available within 200 feet.) " Si, from nearest well-----------------Distance from foundation_ --------------`_.Material --:.--_.----.-.____--___--_____---__-.-_____. No. of compartments--------------------------Size--------- --------- -----------Liquid dept------- ------- --------Capacity...... •- ---------- osak itil� Distance from nearest well_.NA-7'—Distance from foundation----/_-7------Distance to nearest lot line_ ---------- , Number of lines __._�____ _ ___ _____ Length of each line_. _-O.-!_-_____._._.Width of trench__-_.-�-L__-_-!_4 ".-._-___-____- Type of filter mate 42.1 .__Depth of filter material-_��' . .......Total length__ Q _ Q F Seepage Pit: Distance to nearest well.-.--..--------- from foundation__..______-________Distance to nearest lot line----------------- ❑ dumber of pits--- ..................Lining material--------------------_ Size: Diameter-----------------------Depth--------------------------------- f r Cesspool: Distance from nearest well ----------------Distance from foundation -.Lining material-------------------------------------- ❑ Size: Diameter - Depth-"_-,.:------ - - ----------------------------` ---Liquid Capacity---------- ----------------gals. �. Privy: Distance from nearest well........r-_- ---- ------------------------ ---Distance from nearest building-___-_-_-_____-______________---___-_-._-_._ r' ❑ Distance to nearest lot line --------------------------------------- Remodeling and/or repairing descri -------------- ----------------------• ` . ----- --- ------- -- -- ------ ----------------------- ----------------------- -----------A � --- - - -------------------- -------------- ---I-------------------------------------------------------------------------- ----------------------------------------- ------------------- - 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 regulations o the nJaist?Local alth District. i T (Signed) .--/ � A ` ._. -_�'- 2�` 4 --------------------- r Contractor} By:----------------------------------------------------------------------------- - !- _ T'r (Title)---------- ...............-.__............. (Plot plan, showing size of lot, location of system in relation t ells, building etc., can be placed on reverse side). J FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY G -----. Z-P,,-�------- -------------- DATE-�_...1t" 5----------- --- REVIEWED BY---------------------------------------- ---- -------------------------------- ------------------- DATE--------T------------------------- ------------------------ BUILDING PERMIT ISSUED--------------------------------------------------------------------------------------------------- DATE------------------- ----------- --- - - --- -- ------------------ Alterationsand/or recommendations:_- ------ ----------------------------------------- -----•-------------------------------------•- --------------------------•--•---•--------------------------- FINAL INSPECTION BY:. e j..- . ' Date....... -_ -�O' _- � f SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 F.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi. California Manteca,California Tracy,California l E.H.9 2M 1-67 Vanguard Press