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- _ �.a----0.- ----------------------------------- -- ------ ------------- - ----___ ---- _".... __....._-.-.____.-. APPOCATION FOR SANITATION PERMIT Permit No. _a ----------- (Complete in Duplicate) / -------------------- This Permit Expires I Year FromDateIssued Date Issued l<_.:r __��a 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 Prdinance No. 549, JOB ADDRESS AND LOCATIO Owner's Name...-...� �-_ -------- ___-- ,cr ----- Phone-----------------------•-------- - l '� ' Address- -- - ~ 7* Contractor's Name---------- . --------•------------------------ Phone----------------------------------- Installation will serve: Residence U artment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other Number of living units: ..-__ Number of bedrooms __�3_ Number of baths .-_I�Lot size -----15i0_ 3-J_-_"---------------- Water Supply: Public system ❑ Community system ❑ Private V Depth to Water Table -__ ft. 4 Character of soil,to a de.pfh_oQ feef: Sand.❑.._Gravel ❑,_.$andyrLoam ❑ . a-y Loa 0�Cla-y_,❑ YAdobE &LLa dpanw❑ = —.: .. Previous Application Made: (If yes date--------------------j No -,!�6 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.) a ._. C .�M. .. R,. ' Septic Tank: Distance from'nearest--- -- ---_-- Disfa �e( o foundation...-I ---------Mat riaL-- _ ....__-".... _/ _____ .j L .LLiquid d pth .lL f ..CapacitY Ff� ---- No. of compartments-.L----------------Sixe _F`_ _ Disposal Field:i � ;D;sFance from nearest well...��_��____--Distance;from,foundation�----LT------_Distance to nearest lot line_ •�Numbe�r'of'lines---•�------- Length of each line----- f� s g ~ 1�--- Width of trench..... --------------- Type of filter material,5� -Ci pth of filter material___-.�-a�.-.-.-___.Total length-----.-_ �-----------------_-- 5 Seepage Pit: !Distance to nearest well}....................Distance from foundation--------------------Distance to nearest lot line----------------- F-1 #umber of pits.-n-=--_- - , Lining material'_- _-�_"`".SrzE: Diameter-----------------------Depth---.-------------•--- ~ ------------ esspoo : Distance from nearest well__--------------Distance from foundation--------------------Lining material... .__.-_-_.__ ❑ €ize: Diameter.----- ---- ----- -----Depth------------------ ----------------------- -----Liquid Capacity ------------ --- gals. _Priv _ J."'""` ` — —_"' ,. _ y:�z=_®Distance f�mTnearest well. .- _ `"",--=�"�.- " '—�_�'.� �`" -T�= ng _ "-_ ".__-..:. ____"._.:Distance from nearest building._..-___,"............. .. El .� ; Distance to nearest lot line ______...__.+_.- . ------_ - , Remodeling and/or repairing describe))-...-_CIVr/1'-GC " �_, � � 3 -- -- � f - ---_-.fit- A ��r `-�-��-- - ��-��___t-------- I here y certify that,Vhave,prepar 'this application and that the work will be done in accordance with San Joaquin Co/nty ordinances, State/His, and rules"a ,egulations'of the`San,Joaquin Local Health District. h ^�^'�-` - (Owner and Con#Tactor r By:------------------------------------------------ (Title} --------------------- --- ---- -- ----- ------------- - - (Plot plan, showing size of lot, location of systemsin relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------------------------------- '----------------------- DATE-_ ------------- REVIEWED REVIEWED BY ----------------------------------------- - -- -- - - - ------------------------------ -------- - ----------------- ----------`---- -- ' ---._ DATE---- �-��---- �- - BUILDING PERMIT ISSUED #'J'V i.� - ------- DATE----------------- --- ---------------- ---------�---Alterations and/or recommendations---------------------- a ----- -------- -------------------------------------------------------------------------------•------- ------------------------------ -------- -------------- -------------- ------------------------------------------------------------------- FINAL INSPECTION BY:_........... - ------ ---- - � �� -----------•----------- Date ate---------- - ------- ----- ------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT (�/ /✓ 1601 E.Noxelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9Th Street Stockton,CaliforniaLodi,California Mantecar California Tracy,California + F.P.cc' ( / rr��n: