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FOR OFFICE USE: - pp APPLICATION- FOrSANITATION PERMIT Permit No. _ 1................ - - --------------------- -------------- --------------- (Complete in Duplicate) - ___ __ __ --.._.- This Permit Expires i Year From Date Issued bate 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. �7 JOB ADDRESS AND LOCATION----- , . .c----x---------�--------- --------�--�-�'Z -_...1� C..-- / ------------ Owner'sPhone G � � 0. Name------------- - - ------------ ------ 1 �l - --- ----- -- -- --- Contractor's Name------------------------- -------- ----- - =-- ----------=1------------------ Phone...- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -------- Number of bedrooms _, __. Number of baths - - Lot size ---La_el.....q�.d _ _^---------------- Water Supply: Public system ❑ Community system ❑ Private Ug-tepth to Water Table -------- ft. Character of soil to a depth of 3 feet: ?Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe [B'-Hardpan ❑ Previous Application Made: (It yes,date---------------------J' No Dg- " New Construction: Yes pT"No ❑ FHA/VA: Yes ❑ No �•-- TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permittedif public sewer is available within 200 feet.) �` s --�----.Material- - -----�t�-G I Septic Tank: D stance from nearest wet{-J------ Distance from foundation____, __._ _------------------- .�{ P A-----------------Size__! ..A-f0� ----Liquid depth---------------------_Capacify_fjzO"q------ Disposal Field: ------ Distance fromrnea est well yd__L.-Distance from foundation-__I. ------Distance to nearest lot I�----------------- Number _-` �__--- Number of lines_-__-�!............ .`r` Length of each line----------§"21��lP------_.Width of trench_._vZ/_-..-----__-___--..---- DQ Type of filter material---_ST S {_=Depth of filter material--.,r!- -------------Total length._....`2-V- ---------------------- r` Seepage Pit: Distance to nearest well-----.----------------Distance from foundation--------------------.Distance to nearest lot line----------------- r ❑ Number of pits----------------------Lining material-----------------------Size: Diameter-------r - -- - -- Depth-------------------------------- Y, Cesspool: Distance fi-am nearest well----------------Distance from foundation- ____'.__ _Lining material ❑ Size. Diameter------------- ------- ----------------Depth------------------------------ -- -- ---------------Liquid Capacity- --------------------------g�ls• h Privy: Distance from nearest well--.-._--,..----------------------------------------Distance from nearest building---__-_---_---._---.----__-_-_-_-_--. `. ❑ Distance to nearest lot line-------- =--------------- -------------------------------------------------------------------`------------------------------------------- i 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 F-Iealth'District. d �{ C.- r .-- t -V~ ----- -----:----Owner and/or Contractor) (Signe )-----------+- --------T------------- - -01 ` ----(Title)- (Plot plan, showing size of lot, location of system in relation to v+ As. buildings, etc.,,can be placed on reverse side). V ` FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------1- -------` ------. NTE----- -. � � 7--------------- ----------- REVIEWEDBY------- ------------------------------------- --------------------------------- --------------------------------------- DATE------------------------------------------------------------ BUILDING PERMIT ISSUED--------------------------------- --------- ° " . .-,. .-- DATE=-=--------------------------- ----------------------------- r 4 0,, 70..-----�5----Alterations and/or rata datia -. _,-__ , P{ A�xl--- P =� -'------- ------------------------------- --------------------------------------------------------- i FINAL INSPECTION. BY:----- - ........ - - - -- -- `!e�1 Date----__-:- �-------- /4e -- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 Wes[9th Street Stockton,California Lodi,California Manteca,California Tracy,California