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----------- -- -------r�_? _. APPLICATION FOR SANITATION PERMIT Permit No. _ f- 4 z�F =5 --------------------- -- (Complete in Duplicate) �- Date Issued .-d-A -- --�-------��-- ---- --- ---� _- -�. 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 id compliance wr ounty Or n No. 549. JOB ADDRESS AND it TION -- - ............ �`�U Q.(��lL: �/ �•` ----------------- > :- - _ � Owner's Name_-_---.-�- -: ----------------- --.__ Phone Address----------------- _�:._ .. Contractor's Name---- II D ? 1 f -�t------•------------- Phone-M.-4l_7 -------- Installation will serve: Residence [ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -- ----- Number of bedrooms Number of baths ---1--- Lot size --- -x Water Supply: Public systlem `P�f Community system ❑ Private ❑ Depth to Water Tab 101stemft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 1A, Hardpan ❑ Previous Application Made: (If yes,dote...`-----------------I No New Construction: Yes ❑ No A FHA/VA; Yes ❑ NoX TYPE OF INSTALLATION, ,ND SPECIFICATIONS: l w k, (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distancb from nearest well-----------------Distance from foundation--------------------Material__-.-___`__----__._----.__------__- ❑f�,-[5�Itlt) No. oft ------'Size----------------------------•---Liquid depth--------------- --------.-Capacity----------------------- r Disposal Field: Distancb from nearest well-0/0E- Distance from foundation.-ZO__------_Distance to nearest lot line-- �'_.�...-_- 00 i ,jImo+ Numbe'ii- lines---- — r/_.�__- 'Length of each line--. -�_ -- Width of trench _ _-i l tr----- Type of filter material-i--LIIIL Depth of filter material---- _ ---_Total length---_-- (1---:--- Seepage Pit: Distance to nearest well---&W-0-__Distance frgrT foundation-_ , ��-_-.-..p star e to nearest lot line_..___--- r Numbe'of pits.-.01k------Lining material.l�-.��ize: Diameter---2? S' i Cesspool: Distance from nearest well------------- --Distance from foundation-_..____---. Lining material---_--------------..__-------------- C ❑ Size: Mmeter----------------- I 4-------Depth-------------- --- Liquid Capacity--------------------- i�f: } I x q p Y gals. 1 Privy: Distance from nearest well------------------ --_._Distance from nearest building�h .: r- g ---------- ❑ Distance to nearest lot line. ----------------------------------------f ------------------------------------------------------------------------- ------ Remodeling and/or repairing (describe):____ r? ----------------------------------------------- -------- ---- -•- - - 1 ----------------- ----------------- ----- = ave prepared this-a ------------------------------------------------------------------------------------- I hereby certify fhat 11ilpplica�ion and that the work will be done in accordance with San Joaquin County ordinances, State lawn, and es and g ations of a San /Joaquioval Health District, -� I� - _ --------.- Pwner and/or Contractor} (Signed)BY= ••----------�- �'� `-c. Cl' --- -- ---� ----- - ' -------- -----{Title}----- (Plot plan, showing size of it, location of system in relatio to wells, buildings, etc., can be placed on reverse side). i 17 FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED Y___-_�_t- a-� �s_-.-___-__ ------------------ --------------------------- DATE------ �` --------------------- - BY------------- ----- ' DATE----- - -'------- ------------ -------------- ---------�----- --------------------------------- •- BUILDING PERMIT ISSUED-------------------- DA-TE------------------- --------- ----------------- - - -------------------------------------------------- ------- - ------------- Alterations and/or recommendations:_--_ .' f_f,�.- _:(p. _ ,».., .11 ---------------------------------------- -------------------------------- -------- -------------- --------------------------------------------------------- ----------------------------- ----- ---------- - : ---- ----------------------------------------- FINAL INSPECTIONBY:. Q...._.& 1�,s , s Date - =7 SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Na:elton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F•P.CC. �I