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FOR OFFICE-USE: -- -- 1a - -------------------- ---------------------------------- ` --------------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. U� - - ------------------------------------ -------------------- � � (Co`mplete`in Duplicate) ff Date Issued --------------------------------------------------------- This Permit Expires 1 Year From Date Issues! 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. S49. , JOB ADDRESS AND r LO,C�A�TfION _ __-.__- __---_C- ----- -Owner's Name ---------• -- � - - - / - - --•--------------------- Phone---Z/- Address-----------------------/_5-e'.5-p.-- ,�<a-� ��--------------------------------------------------- Contractor's Name---------�-�-e_142O-�1sAA49_01-. -----•----- Phone----------------------------------- Installation -------------•-•----•- -Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel 0 Other Number of living units: _ ___ Number-of bedrooms. Number of baths . _ Lot size Water Supply: Public system Community system ❑ Private ❑$: Depth to Water Table -490- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Ki_�ardpan ❑ Previous Application Made: (If yes,date--------------------) No �New Construction: Yes [j--g-o ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: l (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well____ -'_____Di # n fr �oundation----J�_--- Ma aerial----[1s'?n'G YeTcp ! .2 � + � No. of-compartments_.-..__.Z -------------Size ��T---------------------- Liquid depth----`Z'u- ci__'_ _-Capacity_/_.7 --'" , Disposal Field: Distance from,.nearest well.._. -"_-----Distance from foundation____.---------Distance to nearest lot line___S__�.... Number of lines----- ...... ______Length of each line---,/r�___----------------Width of trench_____, Type of filter material_ at>[ Depth of filter material-------/z7'_-------Total length__ 1: ?' 21�0�� :_. Seepage rt: Distance to nearest well------ ---------Distance from found tion_.-A�)_ --.__-.Distance to nearest lot line..--3' Number of pits-_A. Lining Diameter= Z'A3Depth__--...--ZS---_..______ LM Cesspool: Distance from nearest well ' tante from•foundatio ............ Lining material------ 1Z El Size: Diameter'.-•-4-= f" `"*-.a th--------------- ________ ___ _ ___ __ ______ _Liquid Ca acit _gals. I Priv Distance from nearest w I_-_-_____ __ "� ''' _Distance from nearest building ❑ Distance to neares,t'Iotl ine- - - ----------�---- --=_-----------------------------------------------------------------------------------•------------------ Remodeling and/or repairing ��escribe ...-'___ . ` - _ _ -- •- ------- --------- ------- --••------------------------------------------------- -- ----- - - s-- " ----- - --------------------- ` ------------------------ ------------------------- tt =' ------------------`---- --- ----------------------------_-------_____________________ ------------ -------------- _____________________________________________-_____---_--__.------------________.________--__________-..-_..__-_----------------_ F•_. I hereby certify that I have repared this plication and that the work will be done in accordance with San Joaquin County ordinances, State laws, nd rule and egula ' ns of the San Joaquin Local Health District. i - (Signed) ° � -- t y� [Owner and/or Contractor) 1 t BY:---•--------------------------------- -- ° ' `-----{-----.."Tide)------ --- (Plot plan, showing size of lot, cation of system in relation to v✓ells, buildings, etc., can be placed.on reverse side). FOR DEPARTMENT USE'ONLY APPLICATION ACCEPTED BY----------- ----- ---- DATE /`6 REVIEWEDBY--------------------------- -.---- - -------------- -------------- ------------------------------- DATE----- BUILDINGPERMIT ISSUED---- --------- ---------------------------------------------•-------------------------------------._ DATE------------------------------------------------------------- Alterationsand/or recommendations:----------------- ---- --------- --------- --------------------------------------------------••----•------------------------------------------------------- /40 t ---------------- --- - -'--- ----- --.-_--_- --'-- -------------. .!r ---------------- ----- - ----------------------------------------------- ----------- ----------- ------ ----------------- - - ------------ --- ---------------------------------- ----- ---- ---------------------------------------- -------------------------------------------------------------------------------------------------- ------------------ ------------------------------------ - FINALINSPECTION BY:- - ----------------------------------------- ------------ bate --------------------- - - ------ ---------------------'=-------�-- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hasolton Ave. 300 West Oak Street 124 Sycamore Street 205'W t 9Th Stmt 1Z I Stockton,California Lodi,California Manteca,California l Tracy,California t o•