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—FOR OFFICE USE: 4. ;�jl '1 ,S. -"--, -:�� ------------- ° APPLICATION FOR SANITATION PERMIT Permit No. mor - --'� ----------- ----- ---------- ----------- ---- --- ------ (Complete in Duplicatd) ___ ______________ This Permit Expires 1 Year From Date Issued Date issued _�f __ � 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 ' of i,I ---- JOB ADDRESS ANND/LOCATION.../1'---o M ----- Owner's Na a GC/ ------- �1 - -------- lir------------------------------ Phone---!�--�-� DI Address '¢ .�I------------------------------ Contractor's Name-------------- - ----- ----- '--------------------- Phone-- la1 - 1• _ •li Installation will serve: Residence ❑ Apartment House ❑ Commercial V Trailer Cou t ❑ Motel ❑ Other ❑ Number of living units: -------- Number of bedrooms ------ - Number of 1?athsd_.� Lot size ____ "" ____________________________ 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 ❑ Adobe [Hardpan ❑ Previous Application Made: (If yes,date-----------_--------) No 9KNew Construction: Yes �o ❑ FHA/VA: Yes ❑ No ❑ ' `TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted ifublic sewer is available within 204 feet.) , I Septic�T nk: Distance from nearestwr.J :�o� .__Distance from fou ud ation_��___-_.__._.Material_��-_"P"�''.___________.._--__ -.. No. of compartments---3..................Size_-511X XZ9._!_ii_'_.Liquid depth____'h�__--..._..___-.._Capacity_R S ili / Disposal ,ield: Distance from nearest well-----------------Distance from founldation_/Q_ �_.__�_.Distance to nearest lot line_,_____._... Len th of each line l /____�_aD___.Width of trench.__ _ _ ----------------- Type _____ r Number of lines._____..._.. g __-____._- Type of filter material s- OGk-__Depth of filter material__19__.._______-Total length-------------------J.?Q__-_-__-- �. Seepage Distance to nearest well.---------------------Distance from founHation---,1.0__"_____.Distan Distance to nearest lot line__.S_--_.__ Q [] __Linin material-5-_ O Size: Diameter__..__ / \ Number of pits------==3---------- 9 - � -�� ------- Deptn- - �-S-------------------- e1� Cesspool: Distance from nearest well-----------------Distance from foundation-----_-----------_Lining material......__.__________._________.___.. ❑ Size: Diameter---- --------------------- ------- ---Depth-- -------- ----------,II-----------------------------Liquid Capacity---------------------------gals. IPrivy: Distance from nearest well-------____-----------------------------------__Distance from nearest building.------------------.------------------- I ❑ Distance to nearest lot line------------------------------------------- - - 11-- -------- ------------- - --------------------------------------------- r Remodeling and/or repairing (describe}: - ------ -- � Q--r--- ----- - - ----- ------------- --- 1 S dw___�i ----- ' ArIc --------------------—---------- ---------------------- ---------- I •----�- PP q Y herebycertifythat I have re ared this application and t t the wor�""' ill be done in accordance with San Joaquin Count ordinances, State Paws, and rules and regulations of the San Joaquin Lacaialth District. ----------------------- (Owner and/or Contractor] (Signed) ----- -- ----------------------------------------- By----------------------------------------• - By----------------------------------------• r�J �-1 -------------(Title).--- - ------- --------- --------------- - ------------- (Piot plan, showing size of lot, location of system in r tion to wells, buildings, etc., can be placed on reverse side). ap FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------ - ----�----�-----=Ft-`- ------ -------------------- DATE------------- ----------------------- fREVIEWED BY----------- ----------- -------------- -- --------- ------------------------------------------------11 DATE------------•----------------------------------------------- 1 BUILDING PERMIT ISSUED-------------I----------•------------ --------- ---. ----------- ------------------ DATE-- ---- -------------------------------------------------- Alterations and/or recommendations 11 .. /._.-� - -----•-------•--" IJ 2 -------------------------------------- _ - ------ ?--- � -.----ir----------- ---------- = SII= ---� - R-- _ �. . �- I! ---------------------- ` ------------ Date ---------- l 1 --------------- FINAL INSPECTION BY:----- � ________________ SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Ha=elton Ave, 300 West Oak Street 124 Sycamore Street 205 West 9th Street I Stockton,California Lodi,California Manteca,California Tracy,California �- F.P.rD,