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FOR OFFICE USE: / h Fw e; J - -------------------- - - Ile,- - ----- ----- _ _ APPLICATION FOR SANITATION PERMIT Permit No. ...... ...._!-_ - � -5--------- - --------- (Comple"te in Duplicate) ---.--- This Permit Expires 1 Year From Date Issued Date Issued 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 LOCATION.. = ------- --- ---------- - -� ---1-•----•- « - ,_ f Owner's Name------------------- ------- �C.. ---- ---- .1't�Qe - --s------ -------------------------------------- Phone..t�-4/7a-0--- Address _ / + � G�� el ` j/ Contractor's Name--------- - � --------------------- ------------------------------------------. Phone----------------------------------- Installation will serve: Residence ❑ Apartment House ❑ Commercial [ Trailer Court ❑ M4 ❑ Other ❑ INumber of living units: _- - Number of bedrooms --___ "Number of baths __ Lot size _--- _ -_ / -------_- Water Supply: Public system 0�' Community system ❑ Private ❑ Depth to Water Table ---------ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam [Clay [] Adobe ❑ Hardpan C]- Previous Application Made: (If yes,date.-_.----_-,.--.----) No � New Construction: Yes��No [ FHA/VA: Yes ❑, No E^- TYPE OF INSTALLATION AND SPECIFICATIONS: _ - - f '� " (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ' i Septic T k: Distance from nearest welt-----------------Distance from foundation__/4.__` _Material �.----,------ UT No. of compartments-------- r.-_ Size--- 'X X__4 ---Liquid depth----�- ..-:------Capacity--.��-�4 bispos field: Distance from nearest well-_ - Distance from foundation--- __.___.__Distance to nearest lot line -. Length of each line-----f4�-------------- Width of trench-----024-_--_--------------- Number of lines----____�__.-.-. _ -. - I a �: . f- Type of filter material- --_Depth of filter material---/�-.-.--.---_Total length-----A-------------------------------- Seepag it: Distance to nearest well-___- -----_Distance fr foundation_�w-- _-_.Distance to nearest lot line_-� - - ^'"-'- Number of pits------�___..-------Lining material_ ��n� _.Size: Diameter----ra3_-------Dept h-__.0S� ------------------ Cesspool: Distance from nearest well-----------------Distance from foundation------------77 Lining material------------------------------------- ❑ Size: Diameter-------------------- ---------------Depth---------------------------------------------------`Jiquid Capacity------------- --------------gals. w Privy: Distance from nearest well-----------------------------------------_--------Distance from nearest building------ ___----_._------__-_---------.-. ❑ Distance to nearest lot line �� Remodeling and/or repairing (describe):-----. ''� - ---- -- ------- ----- -- --------------- ----------- ---------------------------------------------- ----- -------------------------------------------------------------------------------------------------- ---------- } ------ ------------------------- - ill --- �------------------------------------------------------------ I hereby certify that I have prepared this application and that the work will be dr}nein accordance with San Joaquin County ordinances, State law s and regulations of the San Joaquin Local Health Qisfrict. r F Al - (Signed)---- --------/Q -x� ---- ----------( ��. w and/or Contractor) k �-+' - `Me I4 BY - - ----------------------------------------------------------(Title)- (Plot plan, showing size of lot, locafionAf system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY___ '------------------------------------------------------------------------- DATE-_-- REVIEWED BY =" ---------------- DATE.------------------- BUILDING PERMIT ISSUED---------------------- -- -- -- -------- ------------ DATE----:----- - - - - - ---- - - - - - _ Alterations and/or recommendations:.---_ _.'l "-65.....-- " -- ¢°�� - .. ''----- K '-------------------------------------------"----- I ----------------------------------------------------------------------------- --------- ---------------------------------------------------- ------------------------------------------------------------------------------ ---------------- - ------------------------------------ --------------------------------------------------------- --------------------------------------------- --- --------------------------- - - -2 FINAL INSPECTION BY:- - Date1-2_ SAN JOAQUIN LOCAL HEALTH DISTRICT 1401 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi. California Manteca,California Tracy,California F.P.Cu.