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t ?- �r4--�' t USE.: .. -------------------------- - --------------------- ! = se r ' APPLICATION FOR 'SANITATION PERMIT Permit No. .�� t ----------- ----- --- ----------- ------------------ --{Complete in Duplicate) __ ______________________ .��. _ - A " This Permit Ex fires 1 Year From Date Issued Date Issued __. /�7 I Application is hereby made to the San Joaquin Local Healfh District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. S49. I. JOB ADDRESS AND LO �T-ION. . � � -•- ------------------- •------------- - Y- Ph�oXne, - Owner's Name -=---------------------- ----------- .; ,..a l ---------------- Address----•----• ---- --- ----------- -"----•-------------- f Contractor's Name---------- ------------------------------------ ------------ -------------•----•------------- ---•---- , --- -------------------------------------------------------- ---------------------- Phone.---�� Installation will serve: Residence p f .her ❑ Apartment House ❑ Commercial ❑ Trailer Court ' Motel ❑ Other ❑ Number of living units. -" Number of bedrooms �/ i -_"- Number of baths _ _ Lot size.____� / -��_ -------------- Water Supply: Public system ❑ Communit system y stem ❑ Private Depth to Water Table'_(o.<;;;,ft--°i Character of soil to a depth of 3 feet: Sand ❑ Gravel E] Sandy Loam ❑ Clay Loam E] Clay , Previous Application Made: (If yes,date_________________ ❑ Adobe Hardpan ❑ No New Construction; Yes No ❑ FHA/VA: Yes ❑ No ❑ f TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) � --�-- �, + Septic Tank: distance from nearest well_c��'"-.--_Distance from foundatian_�:__ --------- i iVo, of com artments______ Material---- p size...` x•SX`� Liquid depth--------!s��--------- Q G' Capac�ty_s.�_-_G---.fC Disposal Field: Distance from nearest well-_.--Distance from foundation----� ---------Distance to nearest lot line_____ ......... aNumb- of Mines__ ------ G-----------------Length of each line_-_-------�_�-�----- Width of trench-----02- . - Type of filter material____��C_1 ------Depth of filter material_--1- - -_Tofal'. length________. 6."j- t See e Pif"__' _Distance"to nearest well-_/ -----Distance from foundation /CS______ Distance to nearest lot line--- Number of pifs--_._ 7.-----------Lining material--/ Q L'f Size: Diamefer.---!:Z�1'17---- Depth----- --~ Cesspool: »Distance fi-onnnearest well-----------------Distance from foundation....................Lining material_.._______-,_--_"----__--__---- ❑ Size: Diameter--------- --- ----- ---- -- -------Depth------- --- Liquid Capacity_ -------- ....i.. ... _.Y. ,.� , - - ------ ---- -------gals. Privy: Distance from nearest well------------------------- -- --------Disfance from nearest building .�,.�. !;� . Distance to.nearest lot line---._..___"_,_______------------ tb ----------------------------------------------I---------------------------------------------------------------------- Remodeling ------------------------- --- ------------ Remodeiing and/or repairing (describe):__`_______________ ----------------------------------------------------------------------------------------------- ------------------------------------ - -------------------------- r ------------- 3 --------------- ----------------------------- -- --- ----------------------------------------------------------------- ------------------------------------------------ ----------------------- 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)---------------------------- - --------- �--------- - - ---------------------------------------------- --- ------------(Owner and/or Contractor) By: �----r ----- (Plot --- --- -----(Title)------------------ .. ----------- -- --.._..---- -------------- {Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----------f �._..- l-----_-_--- DATE_ ------------------------ REVIEWED BY --- --------------------------------- - DATE BUILDING PERMIT ISSUED------------------ DATE - ----- ------ -- Alterations and/or recommendatiorts:-------- "- 4 ------ --- -- �-� � 4 _._._ --------- [� — IZ- ...........� d FINAL INSPECTION BY:___-- N 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.F.CO. y'