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---- ------ -rurc urrlt-t�5t: � G _____ _______________ ______________'- l9 G________________ hr--_ ' `"APPLICATION FOR- SAMTATION- PERMIT Permi/No. _i� ---- --------------------------------- {Complete in Duplicate) ! --------------------------- ------------- ---------- This Permit Expires 1 Year From Date Issued Date Issued -e TION 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. Oe ADDR ,L:v _ � 11-7 �3�'D -z2- ESS AND' �l�r�----��G�G� Owner's Name-------- _--- � ` ---------------------------------------- -------------- -------------------------------------- ------ Phone Address----------------- !� Contractor's Name----------- - i ---------------------------------------- Phone---------- Installation will serve: Residence ❑ Apartment House ❑ Commercial Trailer Court ❑ Motel ❑ Other ❑ � Number of Diving units: __-__ Number of bedrooms ..-- Number of baths _a2-_ Lot size Water Supply: Public system [Community system [I Private E] Depth to Water Table s_ ft Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: (If yes,date--------------- j No L�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.) CAJ` Septic Tank: Distance from nearest ___-Distance from foundation_-_Z,�_---------Material -_C�� -_S v L Er� No. of com artments_ ---- -------- , --- -- -- -j.... _iquid ---�/--- -- -----_Capacit)&��_ - ---- Q Disposal Field: Distance from nearest well-________- Distance from foundati 4e NNumber to nearest lot line_ umber of lines------r117-_/____r_-- -- -.--- Length of each line---/. /-`--------------Width of trenchrZ__`------_.-- Type of filter ma rial(-�__- -. -Depth of filter material_./-P --Total length-__lam-=d__-___---__ Seepage Pit: Distance fio nearest well_____.-._ __-____Distance frim foundation___. ._--___.Distar�e to nearest lot hne____• .'�__ Number of"pits__ ^__.___--___Lining material_ _�--� -___Size: Diameter__ , --.----__ pepthr _-.___ - ----------- Cesspool: Distance from nearest well_--___-_-__.__Distance from foundation--------------------Lining material___...-___-------___.___-_.------ ❑ Size: Diameter--- I---------------------------- ---Depth--.------------ --:--------------- t ------------- Liquid Capacity- ------------- ----------gals. Privy: Distance from nearest well -----------------------------------.-Distance from nearest building ❑ Distance to nearest lot line___________________ ._ --------------------------------------------------------------- Remodeling and/or repairing (describe):---- -- -------- _ fa ---------------------------------- t hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County X ordinances, State laws; and rules andlregulat�i�o ss of the San Joaquin Local Health District. (Signed)-------------------------- ----- .' l - --- - -------------------- --------------------------- --------PlArnor � Contractor) ------------ Title------ �` . _. .---- - - - { ) - - {tel/-c.---------- ------------------ (Plot plan, showing size of lot, location of system in rel to wells, buildings, etc., can be placed on reverse side). -i- # FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY --------- - ------------------------------- ------- DATE -f - + --------------- VIEWED BY ---- DATE --------------------------------------------------------------------------- BUILDING PERMIT ISSUED------------------------- -__------- Alterations and/or recommendations:-____-- DATE . . = 9:� �1 ------------------- ---------------------------------------------------------------------------------------------------------------------- ------------------------ --- -------- ---------- ----- - ---------------- -- --- Date------ FINAL INSPECTION BY:_.1IO-___�- ,. r ' SAN JOA UIN LOCAL HEALTH DISTRICT r 1601 E.Hazelton Ave. , 300 West Oak Street 124 Sycamore Street 205 West 9th street t Sfockfon,California o. Lodi,California Manteca,California Tracy,California y�