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FOR QFFICE4JSE: = r ---•---------------------------------------------------- 9 .1 APPLICATION FOR SANITATION" _ Permit No. ---�._---- t --------------------------------------------------------- SCANNED ------------------------------ (Complete in Duplicate) SCANNED ------------ - -------- Date Issued .----�------- _-__-----------------------_------.-._._.__--r_.__-. -. I 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. — This application is made in compliance with County Ordinance No. 549. �J �// JOB ADDRESS AND LOCATION- � ® � I�YtQr1--_-_Edi O- . o p j" Owner's Name------------- r �! - Phone Address----•...-------------------------• ------ -�,_------- 1 - � ----------•--- -��,��-- Contrac#or's Name------------ Installation _______ _ Phone_____ yam.--- f �` Installation will serve: Residence ©�partment House ❑ Commercial ❑j Trailer Court ❑ Mot, ❑ Other ❑ Number of living units: ___/__ Number of bedrooms _�,--- Number of baths __ _i-Lot size -----________G� ------------------- Water Supply: Public system ElCommunity system El Private �pth too Water Table/-;.7- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ©—c.aay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date_..-------- ) No [�' New Construction: Yes ❑ No ©— FHA/VA: Yes ❑ No [!— TYPE OF INSTALLATION AND SPECIFICATIONS: � .�— _ -...._ _ (No septic"tariff or cesspo`of petmifted�if publicc sewer is available within Septic Tank: Distance from nearest well__ ___---Distance from foundation___,l�---------Material ____ _- - - ____-._____.� 0� No. of compartments____-.. -------------Size__f�7f�.1�`- ---Liquid depth_-� _.- __...___Capacity---,� d-��1, Disposal Field: Distance from nearest ell--c� ------Distance from foundation__1 -----------Distance to nearest lot jNumber of lines--------- ------- Length of each line_._f _�. .Wic�thiof trench---- .. 1-------------- El • i — / € Type of filter material--- of filter material__� f._..__.__Total length--- -Q___---------------------- Seepage Pit: Distance to nearest well----------------------Distance from foundation-------------------- Distance to nearest lot line---------------- " ', ❑ -\lumber of pits----------------------Lining material----------------------.Size: Diameter------------------------Depth--------------------------------- Ir Cesspool Distance from nearest well----_---___..._-Distance from foundation- ------------ .Lining material--.-..._____________:____.______._. N,� I� El Size: Diameter---------- --------- ---------- Depth_ --------------------- ---- Liquid Capacity - -------`-------_____gals. Privy: Distance from nearest well_________________________ _________________.__._Distance frorri nearest building____._.__.-----_.__________---.__...------ t ❑ Distance to nearest lot line -------•--------------------------- ( "---------------•------------------------------------------------------ Remodeling and/or repairing (describe):____-- ___ --------------------------------------- -- ----- ---------------•----------------------------------------------- •- -- --- -------------- 7 - ------- � 1 ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- -------------------------------------------- -----------•----------------------------------------------------------------------------------------------------------- ---------- - ---------- 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 r. e �1 and regulations of fhe San aoaquin Local Health District. (Signed)---------------------- 'f ------- ------------------------------------------- ------ ` mer d/or Contractor) ----------------- =`---------: t (Plot plan, showing size of lot, locati of system in relation fo wells, buildings, etc., can be placed on reverse side). i, FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-,-. riR...0------------------------------------------------------------- DATE 2-1- `� REVIEWEDBY----------------------------------- ------------ ---------------------------------------------------------------------- DAT ------------------------------- ----------------- BUILDINGPERMIT ISSUED------- ------ ------------------------------------------------_-------------------------------------- DATE_ " ---------------------------------- Alterationsand/or recommendafions------------ ------------------------------------------------------------------------- ----------------------------- --------------------- ---------------- 1�K------_o------13.x-----I5R.G FI_1.. >--- 'r(-R-0-`---- i ! ' ------ -- ----- y ri -------------- - ------------ ----- - - -----------..- - ----- --------- -- -----_--------- ;--- ------------------- - -------------- --------------- ---- --- ----------------- ----------------------_ --------------------------------------7 ------ ------- FINAL INSP - ��--�� - - - - ---- Date-------- - ------ - ----------- - --------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Ho:elton Ave. $00 West Oak Street 124 Sycamore Street 205 Wes;4th Street Stockton,California Lodi,California Manteca,California Tracy,California F.F.0 Q. �!