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FOROFFICE USE: APPLICATION FOR SAN1'1`ATION PERMIT Permit No. . �. ------t�- -FIs -/-6- --`-t-'-- +` ?--. --- (Complete in Duplicate) _______________ ____ _ _ _ _____ This Permit Expires 1 Year From Date Issued Date Issued 0_0-5.-6_s Application is hereby made to the San Joaquin Local Health District for a permit to o stru t an, d install t ork herein desc ibed. This application is made in compliance with County rdinance No. 549. tea+ w'd+�i JOB ADDRESS AND L CATION--- ��=f 1w----- Owner's Name __5 F.. ��---- Address------------ ---- -• -- -_ --- - - ---- ----------------------------------------•----------- -•--- ------- --- Contractor's Nam _ Q- __d�'__ _ _ t -------------------- Installation ---- Installation will serve: Residence ❑ Apartment House ❑ Commercial Trailer Court ❑ Motel ❑ Other . N Number of living units: ___ Number of bedrooms _` __ Number of hs 777i--- Lot size ____ _______________________________________-_____.-_____ Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table ft. v Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ardpan o 0� 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.) i "--Distance from nearest well_________________Distance from foundation-------------------Material______..-.----_-_-.___-__________-..-_---____ No. of compartments Size Liquid deP.t ----------------------Capacity--------------------- - os iel ' Distance from near st weil_100._�D'stance from foundation____ __ -._ __Distance to nearest lot line--- ---------- ___.._ o _ Number of lines__________ _ ______ _______ Length of each line__ ___.__..__.Width of trenchp �yC � jV Type of filter maferi p g � e th of filter mate rat___.__ __._ __!� Total length Seepage Pit: Distance to nearest well-1,0.0------- __Distance from foundation-------�.___.Distance to nearest I t li e,____.?-V } Number of pits___r_________________Lining material---[4_a�o_u_n_clafion _Size: Diameter__5_Z�._ __.Depth__- IF-----______________ Cesspool: Distance from nearest well-----------------Distance fro __._._________.- -.Lining material------._____.._____.________________- { ❑ Size: Diameter-------------------------------------Depth----------------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well------------------------------------------------- from nearest building-------------.__________________._._-.-_. ❑ Distance to nearest lot line---------------------- -------------------------•---------------------- -------------------------------------------- -----------__---------- Remodeling - ----------- Remodeling and/or repairing (describe)--- -- ------- ------- - -- - ----- ----- ----- ---�------- ........0 -- - ----------------------------------------------------------•------------------------------------------------------------------•---------------------------------------------- ------------------------------------------------- ---------------------------------------- ----------------------------------------------------------•------------------------------------------------------------- -----------------•---------------------------------------- C I hereby certify thatave prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, ax les and regulations of the San Joaquin Local Health District. fav &P njlt (Signed)---------�E1'TIC—-rA qK--seRvTM- ---------------------------- ------ ------ - ------ (Owner anti/or Contractor) ------- -------- -- --- ------------------ Byc._.?915 E_Miner Ave_, • HO.6-3841 __ __ ---------(Title)-------------------- ---- -- 6 ------------ ---- -- -- ----- (Plot plan, showing size of lot, location of system in relation t we s, gs, a ., can be placed on reverse side). FOR DEPARTMENT USE ONLY / APPLICATION ACCEPTED BY --- - J---------- ------------- DATE � jl �N^ REVIEWED BY ------- ------ = DATE BUILDING PERMIT ISSUED-------------------------- - DATE------------------------------------------------------------- Alterations and/or recommendations:---.__.._/1._� -. �'� ._._ -------- ___ ------------------------------- ---------------------------------------------------------------------------------------- ---------------------------------- ----------------------------------••------------------------------------------------------------- -----•--------------- ----------- ---------------------•------------------------------------------------------------------------------------ --------------------------------------------------------------------------------- FINAL INSPECTION BY:___ -~ Date------�1� ------ �-( - ----- --- - -- ----------------------------------------------- /_. SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.CO.