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FOR 9FFICE USE- Permit r ` _:e;i::�> rr,--�_ � APPLICATIOW FOR SANITATION PERMIT Permit No. .__-.-(•----__-•- - �_---_-- (Complete in Duplicate) �l i! Date Issued '( 1 ' ----------__-- rThis. Permit Expires 1 Year From Date Issue Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the wor err n/de�cribe .� This application is made in compliance with County Ordinance No. 549. fa(J �� ej tom... JOB ADDRESS A D LOC Ti Owner's Name --------- - - ------------------------------ Phone ... ---------------------------------••-------------------------...---•-----------•------------•------ Address / � �`f` ' ., 'may�j Contractor's Name--- � '� £' ----- ------ ------------------ Phone f Installation will serve: Residence [Apartment House F1Commercial ❑ Trailer Court El Motel ❑ Other ❑ Number of living units: --/--,,Number of bedrooms __ Number of baths __/__ Lot size __ ---- r 1 Water Supply: Public system ❑ Community system ❑ Private �epth to Water Table _!W (f. L: Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ 1.Clay,Loam Clay E] Adobe C] Hardpan E]Previous Application Made: (If yes,ldate_.- ) No ❑ ` New Construction: Yes El No E] FHA/VA: Yes ElNo El r TYPE OF INSTALLATION AND SPECIFICATIONS: R (No septic tank or cesspool permitted if public sewer is available within 200 feet.) l C�19 y 5 Septic Tany: Distance from nearest well________________Distance from foundation---------------------Material-__-------.------------_- --------------------- No. of compartments-------------- ------ - Size------•---------------------=---Liquid depth------y----- -- -------..Capacity �y________.Dlstance to nearest lot Disposal Field: Distance from nearest well--_�L�_._Distance from foundation__ ___ � Number of lines--------`--------- -- ------ ength of each line---t�_'_ -� Width of trench_,-__ -----------------------t Type of filter material_, Depth of filter material--� Total length --------- r ( ___.___.Dista ce to nearest IotJne_e��___-.. Seepage Pit: Distance to nearest well-�� __--__Dista nce fro lfodation__ f Number of pits:___-____.---- Lining material__- .-Size: Diameter _..._-_.-_-DepthrZP--_.,* =--- ;'1 Cesspool: Distance from nearest well__._________---_Distance .from foundation--------------- ----Lining material---_..._._._..__________.._-__....___ 9 ❑ Size: Diameter -----------Depth------ --------------- Liquid Capacity - gals. Privy: Distance fromkearest well--- --------------------------------------------Distance from nearest building---------------------------------W w � I ❑ Distance to nearest lot line--------------------- --- 0 - ----------------------- -- Remodeling and/or repairing (describe)-----____ ---------- --- it ---------------------------------------------------------- ---------- ------ --- i__- ---------A-------------------------------------------------- ' . t ' ------------. ---------------- . ------------ -------------------------- - -� I b hereby certify that I have Orepared 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. ( l ! ---- Contractor (Signed) L. (Ti#Iep - -- -- ------------- -- ---- --------- (Plot plan, showing size of lot, location of system in r on to wells, building s, etc., can be laced on reverse side). FOR DEPARTMENT USE ONLY i APPLICATION ACCEPTED BY--- - --------- ------`��_ ::_--- ----- ------ DATE-------`--- v-----------r---------- -- --------- REVIEWED BY--------------------------------------------- --- -- - DATE-------------------------------------------------------- --- BUILDINGPERMIT ISSUED-------------------------------- _ ------------------ -------------------------a._ DATE-------------- Alterations and or recommendations:--------------- `-r f'V------- � = --rl Lcc-,--y ----- ------------- J ------------ �' - - ---------------------------------•-•----------- ---------------------------- ---------------- ------------------------------- - _- -- ---- --- -- s�� 4_�_f . 'tel Date---------INSPECTION BY:.---- ---------- - -- TSN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. + 30/ West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.0 V.