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" t � OR OFFICE USE: --------------------- --------- N� t�l -' - __ ______-___ APPLICATIOFOR SANITATION PERMIT Permit No. ------------ --------------------------------------------------------- - (Com4lete in Duplicate) 0�4 r This Permit Ex iies 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 descfihetl. This applic t'o s a in cc}yryplia with Count Ordipance No. 549. �' 0W .�,4 40/4-, , XJOB A DRE55 F�iV -LOCATION S-1- --d'-- Cltt7 / -J� 71�-. ..--A / //(fc� ' --------------------- Owner's Name---------- I4R - Phone Address--------------0 --- ,�`�----400 24_-022-4p ------ Contractor's Name-----_f'� mp---- ---- ---------•------------------------------------------------------------------- Phone---------------------------------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _- _. Number of bedrooms __. Number of baths /____ Lot size _ ..e1_`'�°��'__________________________ Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table -------- ft. Character of soil to a depth of 3 feet:. Sand Gravel Sand Loam Clay Loam Cla Adobe Hardpan $ P ❑. r ❑, Y.._ ❑ Y � Y ❑ ❑ ❑ 3 Previous Application Made: (If yes,dote-----------,--------) No New Construction: Yes FHA/VA: Yes [ems' No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ` Septic Tank: Distance from nearest wio'p---___Distanc from oundation__/. __._.____.Material_(rs 'd -----.------ No. of compartments .__Siz p ��/ ..____Ca acit %,-��-_-• f pF- � �` Liquid depth P Y Disposal Field: Distance from nearest well-- __.-."Distan4z fromwfoandation__ ._.__.___Distance to nearest lot line_lP.----____ Number of lines__-__'__.�_�_ "�Length of each line__�'sj__________________Width oftrench.,�__..__�_,___.__.._______-.____ ' ,Type of filter materlalf�,CF4 -Depth of filter material--- ______._---Total len gth_/sa3_ -------- Seepage ______-p g �.__ ��_��_.Dist`nce to nearest lot I�e_�d--- �__- I/`` See a e Pit: Distance to nearest'weiL��--469e. Distance from foundation____ Number of pits___. _.___.------_---Lining material_e40if4___:_Size: Diameter f, Cesspool: Distance from nearest well--------------_Distance from foundation._.------...........Lining material------------------.------------------- V ` - ❑ Size: Diameter- ------ ------- ------------------De th--------------------------- --'------ --------------Liquid Capacity--------- ------ ---------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building.____...-____.____.___________..__..-__--- ❑ * Distance to nearest lot line-----------------------'•----------------------------------------------------- ----- --- ------------------------------ Remodeling and/or repairing (describe):--------- ------ /1 A�' ------------------- -------------- - 4i -------------------------•----------- --------------------------------------------------------------------------' --------------------- -- -- - ----- ------- ------------------------------------ •--------------------------------------------------------------------------------------------------------------- I hereby certify that l.have prepared this application and that the work will be-done in accordance with San Joaquin County ordinances, State laws,�and rules aIt regulations of the San Joaquin Local Health District. (Signed)------------------------- - --------- - ----- --- - -- --Pion -------- - ----------------- -------(Ow"F_a�r'Contractor) . h �Y- (Title) ------ -- --------- ` (Plot plan, showing size of lot, location of system in r to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY ; APPLICATION ACCEPTED BY------- ----- ` c 'A—, ------------------------- DATE:------ .. pREVIEWED BY-------------------------------------- ---------------- ------------------------------------ DATE------------------------------- --------------------------- BUILDING PERMIT ISSUED----------------------------------------------- ----- -------- --------------------------------- DATE----------------------------- f.. Alterations and/or -- -'-I--- - recommendations , �___ ____ t ____�., 7- ----'--------------'-'----'---- L .___.___ - -- -'--- �'-`_-"'a'------ � ' '-------'------'---' ---'-- ---- --- - - --`-_--_ ---- I ---------------- --------'--------- --------'-'------'-----------------..------' ' '----------'-----------------------' --------------------------- ----------------------------------- -------------------- --------------------------------- -----•-----------•----------- r ..i[�-L G`3�' - -- ------- Date------------------------ . FINAL INSPECTION BY:.----...�...... .:......'-'------�------'-- - --- -------------- ----'------------------------'--- SAN JOAQUIN. LOCAL HEALTH DISTRICT 1601 E.Haselton Ave. 300 West Oak Street 124 Sycamore Street xp '205 West 91h Street Stockton,California Lodi,California Manteca,California 5 Tracy,California