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` FOR'OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. ---- ------------ ------ ----- -------•--- _. J...d.-_...� ---------------- - (Complete in Duplicate) Date Issued __- ----_--.-_------ - - --------------------- s--_.-_._._ TliiPermit 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 Ordinap No. 549. C'I4M ER ' JOB ADDRESS AND LOCATION..,--:77 ON 77-------- ~, ��P ` 'A--�l---/�U� /• �C� �-I RC?1= AL1 Owner's Name------ fAI - ( D 1-- f ------ --------------------------------- ------- Phone-- ---------•--------------------•----LA +.f__R.0_�--------------------------------------------------------------------- rAddress VIt 13 Contractor's Name_.-----• - S!M—W. `------- ----- "----------------------------------?bone----------------------------------- Installation -------•---•- ------Installation will serve: Residence-�( Apartment House ❑ Commercial ❑ € r-a ler Court ❑ Wotel ❑ Other ❑ Number of living units: --------1Nurrlber of bedrooms_.T__ Number of baths _- _ Lot size ----4Di __f______________________ Wafter Supply: Public system `-Community system ❑ Private ❑ Depth to:Wafer Table ----- Character ___Character of soil to a depth of 3 feet: Sand VGravel ❑ Sandy Loam 0 Clay Loam ❑ . Clay;❑ ,„Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date---------------.__.) No [ New Construction: Yes ❑ No ❑! VFHA/VA: Yes ( No ❑ TYPE-OF INSTALLATION_AND.=SRECIFICATIO.NS:_. (No septic tank or cesspool permitted if p^ubl�i�c/ewer is available within 200 feet.) L_ Septic Tank: Distance from nearest well_-- -C-Y..''_t___Distant from foundation__.__-.�� n�/�e 7 i } 4., Material__-. ---------------. size__�t�C-/D/K� L!9ufd depth- } � _� Capacity--- Disposal Field: Distance from arest�el1-C�'6y:==_Distancefr r -f ft- �,tio"n--_:____--:----_---Distan-Ce 2to nearest lot line----------------- Ie Nu ber of lines_._._t__'____ _.. "Le`n th of each line._ z' .Width_' f trench__ ------------------------- --__.Total length _- Type of filter material____Rd G Depth of filter mater-__.._/q-_ -_ g �---q--------------------------- r .-.-__Distance from foundation____________________Distance to nearest lot line..__-_.__-_-_.__ Seepage Pit: Distance to nearest well /-� Linin material Size: Diameter Depth r ❑ Number of pits_____________ g _ _Vy"; Q Cesspool: Distance from nearest well-----------------D�stanc,4f6m foundation---------- ------..Lining material_-.-...-___--_-____--_-__-_-____-___- Size: Diameter---- ------------------- ------------De th-----------------------------------------------Liquid Capacify-.. -------gals. Privy:- Distance from nearest well-------------------------------------------------Distance from nearest building-------------------.-----------___---.-... v . L ❑ Distance to nearest'iot line-----------__:.. �'�' 'f -- -- ---- ---------- ------ ---------------j Remodeling and/or repairing (describe):-------------- ---------------------------------------------------------•----------------- ----------------------------------------- Q -----------------••------------------------=--------------------- i--- --------------------------------------------------------,--------------------------------- --------------•--------------------------- -- --- ' Qr a* ----------------------•------------------- -------------- --------------------------------------- == ----------------------- -----------------------------------------•-------------------------------------- I hereby certify that I"have repared this pplication'.aAcl +haf jh work will be done in accordance with San Joaquin County.r" ordinances,eSlaws,^and r s nd regu ns of the San:Joaquin Lacal Health District. r Owner and or Cont actor�... ... _ � -... . .ter. -•---- ---- 1 �-®.-------(Title)------------------------------------- ------- X (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 - -- L� - _ _ _ _ _._ DATE------ --------------------------------------- A' ` REVIEWEDBY-------------------------------- ------ --------- -- - ----_-_: =----=------------------- :.___:_ ;DATE BUILDING PERMIT ISSUED-------------------------------------- ,_moi - DATE.----- -- :—_ -------- Alterationsand/or recommendations-------- --------------- ---------------------------------•-----------------------•------------------•------------------------•-----------•---- ---------- -------------------------------------------------------------------------------- ------------- - ---------------------------------------- ------------------•---• --•------------------------ --••--------------------- I -------------------- ---------•--------- ----------------------- ------------------------------------------------------------- ------------------------------------------------------------------- ------ ------------ FINAL INSPECTION .-- - ---------------- .............. Date--..- ---/�`-`-lP- --------- SAN - --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 F.R CO.