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FOR OFFICE USE: .. -_---.----_.----------7----------------- APPLICATION FOR SANITATION PERMIT permit No. f ------------------------------------------ -- (Complete in Duplicate) Date Issued _____________ 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. k This application is made in compliance with County Ordinance No. S49. f JOB ADDRESS,,AND OCATION....__.__ ----- - -- ---C u ----- �' Owner's Name-- A " Phone --------- --------------------------- :Li--- --- ------ ---- --------------------------------------------------- Contractor's Name - �..---�---- -- -------------------�.---------------------------- --------------------------- ---- =----- ------------- Contractor's Name--------- �` °C��'�. J ----/ Q ----- - -- .r-- --- '� l. �+^r!�--------------- Phone.- Installation hone� Installation will serve: Residence ❑ Apartment House ❑ ommercial ❑ Trailer Court Motel ❑ ,Other ❑ t Number of iiving units: _ Number of bedrooms Number of baths __ tot size -- ---t ---- �_�fO�--��.C--------------- Water Supply: Public system E] Community system El Private X Depth to Water Table o9Q t{t. I Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ AclobeX Hardpan ❑ Previous Application Made: [If yes,date--------------------I No;K New Construction: YesX No ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest weI{___ Distance from foundation_fV,_r.......MaterialX'*GS--_^r_-----------____._. i x No. of compartments_.-_--� ..-__.-..__Size. r�_ x __Liquid depth--- ______---------- ._Capacity.,- Disposal Field: Distance from nearest well--_-"- _Distance from foundation_.:�f;----Q__._____-Distance to nearest lot line ---- Number of lines_________ _____ Length of each line__.__ ,, __.l�° Width of trench JT ----------------------- g �� - - T e of filter material___ ----Depth of filter materral;�* ,-- Yp p - l�` � _.Total length----'�--�D- ------ �-i-'�J� I SeeWe e Pit: Distance to nearest well-/-/egg_ ____ __Distance from fo n. pdation-___' `-'- Distance to nearest lot line__ f.: y. z F/ � Number of pits.---„�.....•-------Lining material---� �' Size_ Diameter_-�"------_-,--Depth-__,i;7, _4-------------------- Cesspool: Distance from nearest well________________ Distance from foundation q.Llning material.'f=___ -_' ---------------._ ❑ Size: Diameter---____-- Depth__ vt -_ --_ Liquid Capacity ---- - - ---.-gals Privy: L s Distance from nearest well_ _____ _____ ____ __'Distance from ,nearest building _ __ __._______ Distance to.nearest lot line-------------- - -----------------------------------^------------- _ - ----- Remodeling and/or repairing (describe):__.._ -- _--_ k --------------------------------------------------------- ----- -------"---------------. - - -- .---=-- -yip---------- - ---- -- --------------------------- ----- -- -- ------------- ------ ----------- ---------------- ----- - ------------------ ------ ---------------------------- -------- --- ------------ - 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 Health District. (Signed).. _-:-`s-_:_�_'----------------------------- Owner and/or Contractor) 71 ---: - -- - - � - Title By= '� { ' 1 (Plot plan, showing size of lot, location of syste in ation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY l CAC --------------=----------- -------------- - ------------- REVIEWEDBY--------------------------------------------- -------------- ----------------------------- ------------------ ------ DATE--------------------------------- I BUILDING PERMIT ISSUED •---------- - _ r----------------- DATE Alterations and/or recommendafions:_______._ � / ` Al �---_--a------;1-- "--------- C'C- '------------------- ----------------------- ---------- --------------------- ---- ------------------------------------------------------------------------------------------------------------------------ ------------------------------ ----------- ------- ------------------------------------------ --------------------------------- --------------------------------- ----------------- ------ ------------------------------------------------------- -------- ------ ------------ ---------------------------- -------- ” restOok .C.FINAL INSPECTION BY:- - ---- - - ---- -- --- =------ f bate---- - -- -----r1-.-- ----- -� --------------------------SQUIN LOCAL HEALTH DISTRICT 1601 E.Hazellon Ave. 300Street G r' ` 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California