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K)ROFFICE USE: _ — F �4 a ---- ------------------ ------____._ - -- APPLICATION FOR SANITATION PERMIT Permit No. _-2-5e ' .: --- ----- -------------------------------------------- (Complete in Duplicate) --------- This Permit Ex ires I.Year From Date Issued Date Issued --1.7._ � 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. JOB ADDRESS AND LOCP�ThJON ..3L. --- --•---- -- ----- r ; Owner's Name------------------------------------------------- , ' _ .. 1 Phone--/--I- 1------------- � -- ------ ------------------------•------------------ ----- i •-•--------------- --•----------- Contractor's Name---------_:_¢_ ----- ------ ----�--�---------------------- ...........................----------- --- Phone_- - ' Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Cour A Motel p Other ❑ Number of living units: 7_f4Number of bedrooms la._ Number of baths __ __.__ Lot size--------- ___lS � 157.7 Water Supply: Public sys#em El-Community system ❑ Private ik Depth to Water Table-_G_P 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 ,& New Construction: YesA No ❑ :FHA/VA: Yes ❑ No [] TYPE OF INSTALLATION AND SPECIFICATIONS: t (No septic tank or cesspool permitted if public sewer is available within 200 fee+.) . t Septic Tank: Distance from nearest well_6_.__0_.___Distance from foundation_f G----.___-.Material__..__. _______ - ------------------ .�.._. No.,ofcompartments,t___ -------------Size---� ft_CbksS__Liquid depth)__- .�.-._-4......Capacity-_tS' Disposal Field: Distance from nearest wefl.st "'� Distance from foundation__-,-"'G - -Distance to nearest lot line_ Number of lines------- /-"0-------------------Length of each line-------Gi..G__---______I.Width of'trench-------n _5�-.-.-----_--- Type of filter material---/ GC_( -----Depth of filter material__ ��Y_r�-_- -Total p g ` t / / ., See a e Pit: , Distance well.` __GG_-------Distance from foundation------ ..........Distance to nearest lot line._ Number of,,pits.__ 7__.._...__Lining material___-/f d C _-Size: Diameter___ -_47 Dept h__-._ __�$'-'-------------- r Cesspooi: Distance from nearest welL___________ _ ____Distance from foundation____________________Lining material___--.._____________ __._- ______.. ❑ .Size:.Diameter--------------------------------------Depth-------------------------- -------------------------Liquid Capacity gals. Privy: Distance from nearest well_______ -----------------------------._.Disfance from nearest' F1 Distance to nearest lot line-------- - t'building Remodeling and/or repairing (describe)_______________________ --------------------------------------------------------------------------- t ------------------------ ---- s ------ ------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------- ---------- I I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County i ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed)--------------------------------- -- ------- -----(Owner and/or Contractor) By:__---------------- �---------------------- Title __ µ _ -- - -- ----- - -- ------ - P of 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---- -- ---�''t--/-----.-�---��=-�=�------------------------------------ PATE------- - �-----6 - ---� . REVIEWED BY ----------------------------------------------------------- DATE------ BUILDING PERMIT ISSUED---------------------------------------------- - DATE Alterations and/or recommendations:----��-)--- --- --------------- �_..'•-_� ------------f ------- •� �-------�' :�` -z --------------------- , ----------•------- �r ----------------------------------------------------------•--------------------- ------ ------------------------ -------------------------- i FINAL INSPECTION BY:.__ -------_ --- -�•- --- Date------�� --------------- ------------------- / S JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haxelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California �[ F.p,CO. k