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F R OFFICE USE: --------- "------- �--- APPLICAT-ON FOR SANITATION PERMIT Permit No. �—------------ /1.-- _ ----- (Complete in Duplicate) Date Issued �z/ ,1 : 1 This Permit Expires 1 Year From Date Issue 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 L CATI N� - `--- � - - Phone------------------------------------ i Owner's Name----- -- --------------- ---------•-- ---------------------------------- ----------------------------------------- Address----------------- ---------------------•-------------------------------------------------------•---------------•-----------------------•-••-----•----------------------.---- Contractor's Name.._. f � 7� Phone----------------------------------- Installation will serve: Residence q�' Apartment House E] Commercial E] Trailer Court ❑ Motel [I Other [I I Number of living units: _- __-- Number of bedrooms _ Number of baths -"1-".- Lot size ----------------------------------------- -------------- Water Supply: Public system ❑ Community system ❑ Private gi-*-Depth to Water Table -.daft. Character of soil to a depth of 3 feet: Sand F] Gravel F1 Sandy Loam ❑c Clay Loam ❑ Clay E] Adobe®Hardpan ❑ Previous Application Made. (If yes,date--------------------I No New Construction: Yes g--No E] FMA/VA: Yes ❑ No R� TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Y „"-' -------- o�- . Maternal------------------------------- Septic Tank: Distance from nearest well.J�""�-_"--Distance from foundation.- .__""".___." .. No. of compartments_.--.2.._ Ca acit 9-a:0'------ ------ --Size---'�-'�`�-�--�--------Liquid depth-----�--- --------- P Y--- Disposal Field: Distance from nearest wellll"..-----Distance from founda.tion._�d.._---------Distance to nearest lot line_________________ Number of lines-------- Len th of each line_"g-5 -------Width of trench._--Al---------------------- Type of filter material--20AAr--------Depth of filter material-It length------019--- --=----------------- � Seepage Pit: Distance to nearest well---160-__---. .. __Distance from foundation-YO..............Distance to nearest lot line--' -----.- t Number of pits._..----------------Lining material`I��/C" --..Size: Diameter...r�" _- ----------.Depth------t2'r------------- - ------ ----• i Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material---------------------------------a-Is. I ❑ ------Depth----------------------------------------------------Liquid Capacity----------------------------9 . Size: Diameter.___""______________ ' ---------------------------- --------=--- Privy: Distance from nearest well------- Distance from nearest building------------------------------ ❑ Distance to nearest lot line--------------------------------- ----------•---------------- ------------r- --- ------------ Remodeling ----------------------+0Q ling and/or repairing (describe}: ------------------------ --------- ---------- -------------- --------------- ------------ --------- - 1116 ---------------------------------------------------------------------------------------------------------- 2. i ------------------------------------ ------------------ ---------------------------- ----------------------------------- i l 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. ��p p : Si ned - VS ----- (Owner and/or Contractor) -------------------- -- - --------------- ------------------ f-- - ----- --- - --------(Tit e)--------------------------------------- -- --------------- (Signed) - .. SY ----------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). 1 FOR DEPARTMENT USE ONLY 101, ffffi' APPLICATION ACCEPTED BY------ `- ------------------ ----------- DATE REVIEWEDBY--------------------------- - - ------- DATE----------- ----------------------------------------------- yDATE--------------------------- --- ----------------------- ---------BUILDING PERMIT ISSUED------------- ------------- -------------- ----------- -- ------------ --------- r o ' Z 1 h tS �c Al+erations and/or recommendations:-"1.._._'..._-Iq.c--b�._.-.- ��----- -�------ ( ------•----------- ----------------------- -------------------------------------------------------------- ------------- ------- --------- .. ----------------- - --------------------------- : t FINAL INSPECTION BY:-----h.__:_. ----------- --------- ----- ----- 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 F.P.po. ;e