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OR OFFICE USE: /:00 v Permit No. .- ------------------ �. Yj APPLICA#ION FOR SANITATION PERMIT (Complete in Duplicate) Date Issued _f--J _`-�� _- This Permit Expires 1 Year From Date Issued T ------------------•- Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein describe r This application is made in compliance with County Ordinance No. 549. L__4�_____ - - -- -----"----------------------- ADDRESS ANf� OC ION_____ _ ----------- JOB - - - - ----- Ph one---------------------------- .-__ Owner s Name_. -- �r `-------------------------------------------------- '--------------•----------------------•------- = -- Phone---------------------------------- i Address s NameContractor --__ i-------- Installation will serve: Residence Apartment House El Commercial E] Trailer Court ❑ Motel 1:1 Other ❑ Number of living.'units: _-�_-" Number of bedrooms Acpxl � --- Number of baths _�--- Lot size � -------------------------- Water Supply: Public system Community system ElPrivate [I Depth to Water Tablezg� ft. 1 Character of soil"'to a depth of 3 feet: Sand E] Gravel ❑ Sandy Loam El Clay Loam ❑ Clay ❑ Adobe El- Hardpan ❑ VA: Yes R`No F1Previous Application Made: (If yes,date--------- 1 No @---New Construction: Yes �o ❑= FHA/ TYPE OF INSTALLATaON,AND_SP-ECIEICATIONS:_ �+t` t (No septic tank or cesspool permitted if public sewer is available within.200 feet.) �' 1E,-------.MatBr I_ � r ------ Septic --- i Septic Tank: Distance,from nearest well__--_��-"---Distanc�er fr m foundation__ "- ---Size - - ---- -- --- - q pl No. of compartments___.------. -- - 1 -Capacity.–----------- e �15l0 ,��.� L's uid de th__.�= - s�_' Z ---__- Distance- I� line__�r_____------. Disposal Field: Distance from nearest well. _ _.____-Distance from foundation_" _:_�__ r Number of lines-----1*7 --. Length of each line-Xe9. --- r�---.Width of-trench- ---------`--------------•-- W Type of filter material/-," -- _(��Aepth of filter material-__ _ ___ "� __.Total length___.Zr _--------------------- Seepage P' : Distance to nearest well at' --------Distance from fou -ation_ �...-----.Distan�e to nearest 40# line-_ -""--_ Linin ma#.erial_ C Siz . Diameter Depth_ f Cesspool: , Distance'fis n nearest well_____-".______._-Distan e from foundation----- .LAA rial-----------__________-----.________ Li Liquid Capacity --------gals. ❑ Size: Diameter---------------------------- ---- ---DePt�---�- ----------------------------------------- q P Y----- ----------- - Privy: Distance from nearest well-------------------------- - -- ----------- Distarce from nearest building----------------------------------- --- ------------------ ---------------------------------------------------------------- l ❑ Distance to nearest of ine------------------------- �------- ----- -• --- /f�,r Remodeling and/or repairing (describe ---------- ---r �,,%_ taip---_- ------- z ' °---- -- -------- 'r ------ - - = -------'--------------- -`-- k - ----------------------------------- - l� ------ = - - - - - - ---- -- - - --- ------------------------- --------------------------------------------------------------------------- ------- - I here- b- --y certify-- -th-a-t I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rule anons o d regulations the San Joaquin Local Health District. ( for"Contractor] (Signed) --- ....... ...... -(Tale]... - - - -- -.- ------ --- --� ------------------------------------------------------ ----- (Plot plan, showing size of lot, location of system in rela 'o to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY f/a�-. ------------------------- APPLICATION ACCEPTED BY----- ------------------------------------------ DATE_________________"___._ DATE------------------------------------------------------------ REVIEWEDBY-------------------------------- ------------ ----------------------------------------------------------- DATE------------------------------- -- ------- --------------- BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------- -----"- • Alteratio s --'-'/or reco mendati ns:-- ---- ----------------e- ---------------------/ req ._. --- 1 " lj I-d� s s � Date.. ----- FINAL INSPECTION BY-------------- ----,----------- f-l�T. - ---------------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT } 4 1601 E.Ha:ellen Ave, 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California K.P.CO. •