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E FOR OFFICE USE: �,r,��b�5�,�-� /r / - ---------- - �` �'r r F '/~�'� Permit No. ----------------------------- - APP,...ATION FOR SANITATION PERMI - ------------------------ (Complete in Duplicate) / 301� Date Issued ------------------------------- - ___ --.--_------------------------------- This Permit Expires 1 Year From 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. �r ` JOB ADDRESS AND LOCATION------. '...... �1------./7f c1�' Jf�r r Owner's Name-------- - ^� --- ------------------ -------- Phone------------------------•---------- Address �l y6. ` ----------------------------------------------------�----------------------------------------------------------------------- a Phone Contractor's Name---------- °sem----�`--_;�•�`-��` Installation will serve: Residence F1 'Apartment House ❑ Commercial ❑ Trailer Court 2---MotelE] Other El Number of living units:A2—Number of bedrooms --- ---- Number of baths -------- Lot size __._._s - --------------------- Water Supply: Public system ❑ Community system Private ❑ Depth to Water Table 4V ft, Characterof soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ardpan ❑ Previous Application Made: (If yes,date--------------------) NoNew Construction: Yes o ❑ FHA/VA: Yes ❑ No [l-'� TYPE OF INSTALLATION AND SPECIFICATIONS: `` (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic 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--------------------Distance to nearest lot line-_________-_____, ❑ Number of lines-----------------------------------Lengtin of each line------------------------- ---.Width of french--------------.--------------------- Type of filter material-------------------------Depth of filter material-----------------------Total length----------------------------------------- - Seepage t: Distance to nearest-well./C3._O---_-__--Distance from fo dation__.. ------------Di stance t`nearest lot line��,�_._-_- � �` �' ize: Diameter. - _� ls__Depth- ------------------ L? Number of pits_____ _______Lining matereals <'�P2 ,� ,1 :-> P Cesspool: Distance from nearest well----------------- from foundation.._................Lining material------------------------------------ ❑ Size: Diameter- ------------Depth- --------------------------------------------------Liquid Capacity-- -------------------------gals.n Privy: Distance from nearest well-------------------------------------------------Distance from nearest building_------___-._.---_.____.___----._-.-----� ❑ Distance to nearest lot line------- ----------------- ------------- --------------------- ------------------ Remodeling and/or repairing (describe)--------------- - --------------------------- -------- -------- •-------------------------------- -------------------- -•------------------------------------------------------1_e;�-�� --------- ��.� �lt7G ------------------------------------------------------------------------------••------------------------------------------------------------ 1---h-ere---6'ycertify that I have prepared this applica+ion and that the work will be done in accordance with San Joaquin County ordinances, State flaws, and rules and regulations of the San /Joaquin Local Health District- (Signed)--------------&A- V—1--- �.y �=r'�C' � Z.• s r- � c._sEr).-------------------(Owner and/or Contractor) Title --------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------- -------- ( , - DATE -l '� --------------- REVIEWED BY ----- DATE-------------------------- --------------------------------- -- ----------------------------------------------------------------- --- kBUILDING PERMIT ISSUED------------------------------------------------------------- ---------------------- - DATE Alterations and/or recommendations------- ------`-" 4 --------------------------------------------------- ---------------------------------- --------------------------------------------------------------------------------------- ------------------------------------------------------------------------------ - -------- ---------------- - --------------------------------------------------------------------------------------�j - ----------- -------- -------- 14"? FINAL INSPECTION BY:..-. Date------------ � .-�--f -- -------------------- �_�'!-._-_�-�---� - 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