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FOR OFFICE USE: APPLICATION FOR"`SANITATION PERMIT Permit No. - ---------------------- ------------------ - ------------------------ - / -------- (Complete 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�w1ork herein tcribed. This application is made in compliance with County Ordinance No. 549. d��Yl CO � JOB ADDRESS AND OCATION__,44_ l _ 1 -----{�--- 4401Ce----. � � -------- C Irv. - ------------------------- ------------------ Phone Owners Name---- -s-y�.--- --�_��/�.;-----------•--------------=-=°�-------- -- -•---- Address----------------------+l..7XJ-74- ��.-�'E--� -� - -- ------ ---------_f---•----•--------------------------------------------------..__...----- Contractor's Name /Ir ® Phone. .... { F.- .-' z ------------------ ----------------------------- Installation will serve: Residence Apartment House[] -Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __ _ Number of bedrooms Number of baths _o .__ Lot sizer/_L�' --------------__---------------------- Water Supply: Public system ❑ Community system Private ❑ Depth to Water Table X-5 ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application kMade (If yes,date_____________________1 No New Construction: Yes [Plo ❑ FHA/VA: Yes No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) i x Septic Tank: Distance from nearest well ____ Distance from foundation-_.,�e----------Material zeif----- ___-_..'_____._. ' No. of compartments s __.--.-Size__ _---Liquid}LPth�'dr �_'---------------Capacity_.�Q+ ..___ l� p o2 =. ' _ Disposal Field: Distance from nearest well.___ '._--.-.Distance from foundation___ � t ��______.Distance to nearest lot line__1x�_�__._____ Number of lines-------_v-- - s- -_ Length of each line-__ '. _ Width of trench._ _._r____ ' Type of filter material_ _ __ _ `Depth of filter material_._� ��__.__Total length__1 ___ __ __________________ i, Seepage Pit: Distance to nearest well_.______- -_..._--Distance fr�� fo dation_____/Z9-_____.Disc to nearest lot li e__ __._ ®/ Number-of pits___._.. -_-______Lining material___,l!< .Size: Diameter. -_____...__.Depth_si / � t 3 VI Cesspool: //Distance 'from nearest well-----------------Distance from foundation-_-----------------Lining material------.-----------..____.___________ � {'Size: Diameter-----------_____--.--------- Depth Liquid Capacity gI Privy: Distance Distance from-nearesf well------------------------------------------------_Distance from n arest�building----.-------------------------------- ❑ Distance to nearest lot line________________________ ------ ------- -----;-------- ----=--------------------------------------------- ----------- - I Remodeling and/or repairing' (describe: /� --- `�-�- n -------------------------------------------------- Li - / -___________________________________________________________________'___________.__________________-----_____..__.__-___�____ ____ ________________ __________�.__-__-_-_..-.----_---.-..--------_-___________________________________� _ ______________-______-_______.__________i------------------------ �: _ ----- ------------------------------ -------------------------•----------------- - I hereby certify that I have prepared this application and that the work will be done-in accordance with San<Jriaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. Q- Z�� - r (Signed)--------•------------`'----------------- --------- Contractor By:---------------------------------------------------------------=-------------- .. .... {Title a te._.. (Plot plan, showing size of lot, location of system in r 'on to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY t APPLICATION ACCEPTED BY- ------------- -- -------------- ------------------------------------------------------------ DATE----------- � ---------------------{. REVIEWED BY------------------------- ......... ------------ --------------- -----"--=---------------------------- -------- DATE------------------------------------------------------`- ; BUILDINGPERMIT ISSUED---------- -- ---- - DATE------------------------------------------------------------- Alterations and/or recommendations: 1 . ._C!'� ` fes✓- C'� � T�� -=- ti / ------------------------------- F ----------------_--------------------------------------------------------------------_----------------------------------------_-----_--------------_------------------_--------------------------------------------------- ____ FINAL INSPECTION BY:..--�r ----------------------------------- Date----------------`/X ��y------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazellon Ave. 300 West Oak Street i { u 124 Sycamore Street 205 West 9th Street ' Stockton,California Lodn Lodi,California 4 Maie7a cirifor a Tracy,California k F.P.C C.