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FOR OFFICE USE: --------- Gl,`_G_c_ ,..APPLICATION FOR SANITATION _RMIT Permit No. .: - - - �- lZ�----- (Complete 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 and install the work herein described. This application is made in compliance with County Ordinance No. 549. ropyJOB ADDRESS AND LOCATION--------= ----------- - -- ------------------------------ Owner's ----------- - --------Owner's Name ._ r --- ------------------ - ------- ----------------- ----- Phone_.�..-�----S---------.....--••- Z Address--------- <-_-�--•--------------- ---- -----:------------------•-----------•--------------•-------•------•-I---------------------------------------------•------------------------- Contractor's Name - a ` = ---- •----- --- ---------------- -------'-- -------- - - ------------ Phone_ �r.. Installation will serve: Residence [R''_Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __/__ Number of bedrooms _ ._ Number of baths .- Lot size ----- Water Supply: Public system gCommunity system ❑ Private ❑ Depth to Water TableJo_ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe a' Hardpan ❑ Previous Application Made: (If yes,date ) No 0' New Construction: Yes ❑ No B'FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) tic Tank: Distance from nearest well-- --------- Distance from foundation ------------------ Material ----_--- _ _- .._.-_-_-----_-------------` [�.. No. of compartments ---Size------------------ - ----------Liquid depth -------- Capacity--- .................. Disposal Field: Distance from nearest well. --Distance from foundation----lS_'..----Distance to nearest lot line..._.,,7_..'....� Number of lines ----l__-...__._.,,�___ .__.__Length of each line__-�4...____.......... of trench_.--__-_ __ ____________ , Type of filter materia!_ .I.1_�Q.'.:'..._.Depth of filter material---,l_S----------Total length-------------------- ----------- Seepage-Pit: Distance to nearest ----._Distance fro foundation___ _�_._.___.Distance to nearest lot line__._1_5___. 19- Number of pits... ... Lining material__ __ P r_t_1(�`__ Size: Diameter_. --- -------Depth Cesspool: Distance from nearest well ___---_---_-----Distance from foundation _ --- ------- -.Lining material_....- ---------_____________________ ❑ Size: Diameter. .. ----- - - Depth- --- - ---- - - - - - Liquid Capacity ------------------------gals. � Privy: Distance from nearest well----- --------------------- ._- .Distance from nearest building_._ -------_---_________________._.- ❑ Distance to nearest lot line_ ... .. _--------------------- Remodeling _._...__ . ___Remodeling and/or repairing (describe)------------- --- -------------- -- ------------------------------------------------------- ---------- ----------------------------------------- ----------...............................---------- ---- -- ----------- ----- -------------------------- --- ----------------------- -------- --- ---------------------- ------------------------------ -----•----------------------------- ---------- ------•------- ---•-----------------------••----------------------- ----- --•-------- -------•------------------------------------•------------------------•--------- --------------- ---- -------------------- -------------------------------- -------------------------------------- --------------- ------------------ ------------ --------------------------------- - -- -- -- 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 of the San Joaquin Local Health District. (Signed)g ) - =----------------------------------------------- -------_10wner and/or Contractor) BY:--------------- --- ?_ _ r ----- ---- •----------- (Title) (Plot plan, showing size of lot, location of system-ln relation to wells, buildings, etc., can be placed on reverse side). FO DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----- --- ---------- - -- ---- ------- -------_------ -------------------------------- DATE-- REVIEWEDBY--------------------------------- -- --------- ------------------------------------------ ---------------------------------- DATE BUILDING PERMIT ISSUED----------- - --------------- -----•----- DATE---------------------------------------------- on,:and/or recommendations:._.__.._-. 3/� .---�/ dCi ---__---- r -� -� - - ---------- ------ ------ - �.------------�--�=�----- '>,f`_'--�-=�,----- ---- ��.._ 4G:= rte � � � �. --- ---- ----------------- - - - ------•.............. ------•------------------------------------------ ---- FINAL INSPECTION BY:- ------------- Date _ --------- ��-----------------•------ SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E. Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton, California Lodi, California Manteca, California Tracy, California F.P.C O.