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FOR OFFICE USE: _i`�=__.._.�.'.'_ 3-�_- APPLICATION FOR SANITATION PERMIT Permit No. _ ..___ ._ ---------------- ----- -- - ------- -------------------- (Complete in Duplicate) ate Issued 9 ----------------------------------------------------- -- This Permit Expires 1 Year From Date Issued_ D 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. JOB ADDRESS AND LOCAT N..__ __ _ _ ---V-5O ---------- ----- -------- Owner's Name----•----�/ 1 -1-- - Phone Address------•---4_7Q16-..--------C ---- �� t -------- . --•---------------------------------------------- -�---- ---- ------ --- Contractor's Name- 464-- ±.. ----- -------------------------•--- -------------- Phone/ _�,�s�-----cy Installation will serve: Residence k" Apartment House ❑ Commercial ❑ Trailer Court ❑ Mofe; ❑ Other ❑ Number of living units, I---- Number of bedrooms -a-._ Number of baths ---/-- Lot size ___,�B_��`_�_��_101 _________ i Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table S__ ft. Character of soil 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 Ln No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public newer is available within 200 feet.) Pj, ; Septic Tper Distance from nearest'we --jPl1-------Distance.�recjfoundgtion__ 10____._____-Mate),aL___.� f , ..No, of com artments____- ._. __---_---_Size--T_ -jn---Liquid depth-- �___ -------- t - -------- -----Capacity_- -Ott! pwell./M.- ___.____.Distance to nearest lot line__ Dis osa field: Distance from neares .__-Distance from foundation.__ _ -__-_--_- Number of lines------ ----------------- - -Length of each kne........ __ Width of trench.___a--��----_____� ,}� 1/------- Type of filter material.�`� L _ __. _ __Depth of filter matenal_._._jq_-_______._Total length____-- f 1 Seepag it: Distance to nearest alt.... ___ stance fr m fo dation____��________. - to ce to nearest io iine_r Number of pits___- ----------Lining material c � .Sze: Diameter.___ __.---__Depth___.. _.___...,___.__ t� ' Cesspool: Distance from nearest well-----------------Distance from foundation.____._---------___.Lining material___.__-___________.____.-_______.__. ❑ Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity---------------------------gals. Privy: Distance from nearest well-----------------------------------.-------------Distance from nearest building---"'.--------------------------------- ❑ Distance to nearest lot line--------------------------------- ---------------------------------------------------------------------------------------------------------- - Remodeling and/or repairing (describe)--------------- � � ------ -------------------------------------------------------------------- -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- 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, a d rules and regulations of the San Joaquin Local Health District. (Signed) ----------------------------------- Owner and/or Contractor) By:--_------------------s-4�7---- - ----- -------- -------------------------------------------------(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 ONL APPLICATION ACCEPTED BY------- -- --- ------------------------- --------------------------- - _r Cn DATE------ 1 REVIEWEDBY - ------ ------------------------------------------------------------------- -- DATE ------------------------------------------------------- BUILDING PERMIT ISSUED--------------------------------- --------------------- ------------------------------------------------- Alterations and/or recommendations:---- '� 6` ----------- ....... 'z" -----------------------------•-------------------------------------------------- k ---------------------------- - --------------------------------------------------------------------- ------ ------------ ---------------------- --- --- -•------------------------------------------ --------------------------------------------------------------------- --------------------------------- --------------------------- -------------------------- --------------- --1------------------- ---------------------------- ------ --------- -----------------------------------------.----------------------------------- FINAL INSPECTION BY:----------------- ------------- Date---.---.- 1-- . E•.-- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haxolton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street 1 Stockton,California Lodi,California Manteca,California Tracy,California f.p.c o.