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FOR OFFICE USE: --=----------------------------- - 'I APPLICATION FOR SANITATION PERMIT Permit No. .62s>2_...417 '� (Complete in Duplicate) ------------------- ------- - ------------------------------------------------------.� � bate Issued -- . t _..' � '�`;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. Thisapplication ismade in compliance with County Ordinance No. 549. 1 r a x II i JOB-'ADDRESS AND LOCAT77 ION �4,Zo-f�e2 ............ -- ----- ------------------------------------ ----------- Owner's Name ------- -------------- `----- ------- I ' p Phone__ � $/ ri = Address--------1 ............. .......• •---•. ---------------------------- Contractor's - Name------ - ----------------------------------------- Phone.--�---------------------- on will e �pafrt`ment House!R al El Court F] lnstall .Number of livingRunittsnt'�__ Number of bedrooms _._4CNumberlof baths e4Trailer Lot size (Go ll}0 Cher ❑ _ ifl - --4- � II• Water Supply: Public system ❑ Community system I] ;Private ® Depth to Water Table -------- ft. II Character of Soil to a depth of 3 feet: . Sand 0"'Gravel E]. Sandy Loam ❑ Clay Loam C- Clay E] Adobe ❑ Hardpan E]Previous Application Made: (If yes,date____________________) No B New Construction: Yes JK No ❑ EHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) 1 g 11 ® r Septic�• Tank:- Distance from nearest well___��U____ Distance from foundation__../.......r...._Material *, No, of compartments........2-----------__--Size--------------------------------Liquid depth-------------------------Cal! acitya-'F0_-4-----= - Disposal Field:{ Distance from nearest well -_..:Distance from fountfation__�_�.._______-Distance to nearest lot line---t f f___ h 1 JA � - ) Number of lines________ _ ______ __ _.-__.____Length of each line___ 1___________Width of trench II Typesof filter material-9... c C___Depth of filter material-_/-/__g'�'-_--_Total length_ ;v 7FA--_�lI�S_____ Seepage 0it: � Dista Ae to nearest well---Zj,a---------Distance from foundation_-/.5 __.Dista�ce to nearest lot ® Number of pits---._..�-_------__Lining material-----------------------Size. Diameter--_3 k-,--------Depth;.---,_.�_S..____-_---__------ Q Cesspool: "'""'"Di'stas'i'Ce from nearest ! well-----------------D+stance from foundation_.---....._-___--.Lining material--- rt Distance Sze: Diameter----------------- --- ---oDe�. y--_------- _ _eLigu;&Capacity_'-' gats. Priv ❑ Distance from nearest well,.-.---------- --------------------- from nearest building------- Distance to nearest lot lire } ----- --------- ------------------------------------------------------------------------------------ i u Remodeling and/or .r�epai'r�ing (describe):--- - ----------------'------ ----------------------------------------------------------------------------------- ------------------------------ t 'li ll I' l II II----------------------------------------------------- _____ _________________ -------- I ______1 hereby certify that i have prepared this a lication and that the work will be done in accordance with San Joaquin County ordina State laws;.and rules and regulatioys of the San Joaquin Local Health District. {Signed)----- = -*----------- ------------------------------------------------=---------------------(Ownerand/or Contractor) -------------------------- ------•------------------------------------------- ------ --------------=---------------------Title-------------------------- I ---------- ,. �. - i -------------------- i (Plot plan, showing size of�lot, location of,ssystem in.relat�n to wells, buildings, etc., can be placed on reverse slide). �i FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -'--------------------------------------------- DATE_. 4 ` )I" --------- ---------------- 11 REVfE1VED'BY-----------------------------------------------------------------------f ------------------- ----- -------------------------- DATE--------------------------11- ----------------------------- BUILDING t PERMIT II DATE _171 Alteraans andorrecommDndations:- ---"-------o • ------ -- ------ -------- --------------------------------------- ---------------------- ---------------------•----------- 'I a�(`� � • Iit � _. a --------- --------------------- ---------------------------------- ----------------------- -- -------------- ---------------- - --- --------- ----------- --------------=----------------`- ------- ---------------------------------------------------------------------------._. . ----- Date ------------------------------F1NAL INSPECTION BY: -'- '---- ------------ -l ----------_I- 1 SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 west 9th Street I11 Stockton,California1 Lodi,California Manteca,California Tracy,California I! F.P.CO. !I k �i