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r-A OR OFFICE USE: = -� �+[ ------- --------------- ----------- ------- ---------- P1r r LICATION FOR SANITATION PERti.. Permit No. __�.! -- ---- (Complete in Duplicate) Date Issued This Permit Permit Ex ires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Healfh District for a permit to construct and install the work herein described. y This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND L TIONlY{�� (-" ' "''�`�-'.......... Owner's Name '�`� �, '�' ' " -------------------_- Address------------------------ --- -------- ------------- ------------ ----------- --------- -- � Contractor's Nam l--_--"- .."f'f', -1�� 4' hone-_-_� -- - - Installation will serve: Residence �partment House ❑ Comm rcial ❑ Trailer Court otel ❑ Other ❑ Number of living units:_- Number of bedrooms -------- Number of b ths -------- Lot size .//d_________ ___ __ _________________________--.-_ Water Supply: Public system ❑ Community system ❑ Private epth to Water Table 6oft. Character of soll to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ardpan ❑ 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.) Se is Tan istance from nearest wel{-----------_-----Distance from foundation._.___._.___...___.Material------------------------- No. of compartments-------------- ------ ----Siz --------------------------------Liquid depth-;e-----------. ------- Capacity---------- posal F['��Id�-, Distance from nearest well C V-_Distance from foundation-�_ -7'.---Distance to nearest lot line----- -✓`n �� Number of lines._ el . .---. _----- Length of each line.l Fa_________._.Width of trench.._/ ___________________ s Type of filter materia-______- ..Depth of filter material----i--T"I -.Total length-_-_.__--(,_0---------------------- OQ S ,;z' 'C✓`3 Distance to nearest ell_,l @ '�l__ .. istance om foundation_- __._.Di,�tanr e to nearest lot line_.__. W Number of pits.--.�_-...__ ___Lining material__ _. q- ' - --.__ Size: Diameter._-_!/�__�.._�.__ .Depth_1Z.7.a ------__--.-.-_.__ Cesspool: Distance from nearest well ................Distance from undation--------------------Lining material-------------------..---.---------.--. ❑ Size: Diameter- -- -------------- -------- ----- Depth--------------- ---------- --- -------------------.Liquid Capacity----------------------------gals. Privy: Distance from nearest well------------------------------------------ .._.--Distance from nearest building_ ..---.-------_--..______-- 00 ❑ Distance to nearest lot line-- --- --------------------------- --------- - -------------- Remodeling and/or repairing (describe}: ------,- -�---- / ------ �[> � -------------------------------------------------------------- --- --------------------------------- ------------------------------------- --------------- --------------------------- -------------------------------- ------ ------------ .� s 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 regulation ohe San Joaq�cal Health District. (Signed) ' j�� -------- - -- ------------------------------------ Contractor) B --------------------------------------------------- - --------�-- ---------- - ( itle)------------------------ ------ --- -- -- (Plot plan, showing size of lot, location of system in ation to wells, sidings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY . APPLICATION ACCEPTED BY-------------------- - - -- ----------------------------- ------------------ - /-C-DATE----- :. -- ------------- REVIEWEDBY----- - -------------------------------------- -- - - --------------------- ---------- - ---- --------- ------------- DATE------ ----------------------------------------------------- BUILDING PERMIT ISSUED------------- ------------'---- . DATE- ------------ Alterations AE Alterations and/or reconmen ations:._ --- ----------------------- ----- ---- -------------------------- G-- ----'-- ----------------------------------•--------.---------- ------------------- ---------------------------------------------------- - ----------------------------------------- ---------------------------------•--•-- ----------------------------------------------------- ---------------------- -------- --- ----------------------• ------------------------- --- ----------------------------------------- ---- -------------------------------------------------- -- -- ------------------------- --------------------------- - ----------- -- --------------------------------- ------------ -------- ----------------------------------- - ----------------------------------------- ---------------------- ----- FINAL INSPECTION BY• -,-----_=/-------------- - ---- ----------- 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.C q.