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FOR OFFICE USE: I -- � Z----------- 4(6------------IPA ..�. . ---------- ----------------------------- -------- APPLICATION FOR SANITATION PERMIT Permit No. --------- ----------- ------------ (Complete in Duplicate) --- ----- ---•- -._ 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. I This application is made in compliance with County Ordinance No. 549. `s JOB ADDRESS AND LOCATION- A.- ---l�---- --- ---- ------- >-- -r1�} Ut1 / Pr �I El Cmr (d; OwnersName------------------J. P ---' a �` --------------- ------------------------------ ----------------------------- hone Address------------------------ A)-- �------- ``------3�-'/0.--------- ��rt�rrh i �. . Contractor's Name-------- s�.-c• Phone---------------------------------- t Installation will serve: Residence J Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ { Number of living units: ------I- Number of bedrooms Number of baths --/-- Lot size ----- .__tA-----x_.-1 ----------------- I Water Supply: Public system [Community system ❑ .Private ❑ Depth to Water Table ........ ft. Character of soil to a depth of 3 feet: 'Sand ❑ .Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobeo--Hardpan ❑ Previous Application Made: llf yes,date--......... -------1 No ❑ New Construction: Yes;�'No ❑ FHA/VA: Yes ❑ No I TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 204 feet.) 'wTl� 1--- �- Material- ------------------ - No. Septic nk: Distance from nearest well-411..__.__ istance from foundation...____ �--r No. of compartments----------,_- �7 ---Liquid depth--- ----------------------Capacity. a--- /• - Size_ --- - E' Dis osal field: Distance from nearest well Y._t/ -.� Disfiance from foundati n_6d -f - Distance to nearest lotflinel!- ` p Number of lines----------- ---------------------Length of each line___. r------_ZV____Width of trench_-_: Type of filter material-___.-, .�__.__--Depth of filter material----_/r---------Total length_._-____ -------------------------- S f � See a Pit: Distance to nearest well j� _fl ---Distance from foundation d� _ . ____-_.Distarce to nearest lot linecl�st`__ p Number of its.-_- Linin material__.-.--�- ------Size: Diameter.-.--?3--.._ Depth..-__.._�_ _---__----- P '----- g Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material----------------------- y' ❑ Size: Diameter----- --------- -- -------Depth---------------------------- Liquid Capacity - gals. k Privy: Distance from nearest well-------------------------------------------------Distance from nearest building-- --------------------------- _.--------- p ❑ Distance to nearest lot line--- - --------------- ------------------------------------------------------------------ r O 1 Remodeling and/or repairing (describe)-------------------------------------- ----------------------------------------------------------•-----------------------------.-------------------------- ----------------------------------------- ---------------------------------------------------------------------------------- ------------------------•---------------------------------- -- ----- ------------!`------• ---------------------------------- I 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 regulations of the San Joaquin Local Health District. , (Signed)- - fi ------------- - ----- ---------------------------- --------------------------------------- --------------------------------------------------(Owner and/or Contractor) By:----------------------- ------------- - - Title - - -------------------------------- ---- - --- -- ----------------------------- -- i (Plot plan. showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). t R DEPARTMENT USE ONLY f APPLICATION ACCEPTED BY-------------- ----------------------------------------------- DATE -.J'l `'-(7 REVIEWED 8Y -- ------ DATE_ ---- -----.- --- -- -- BUILDING PERMIT ISSUED------------------------- ------------------------------------------------------------ ------------- - DATE----------- --•--- --------- --------------- - - 6. Alterations and/or recommendations:------ �.a .-.�a_�a----------- -= " `�---- , ---------------------------•----------------------------------------------------- ---------- ------------- -------------------------------------------------------------•---- 14L ,< - - ...__ �1��L�, ------ ---------------------------------- ----------------- ---------------- ----- ------- --------- ------------------ -------------- -----.---------- ------------- r FINAL INSPECTION BY--------------- ---- ------------------------------- --- ----- Date 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