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FUROFFICE USE: r f. l }� ------------------- - ----------------- -------------_---------------------------_--------------- APPLICATION FOR SANITATION PERMIT Permit No. ._Z-d -------- -- -------------------------- ------------------ (Complete in Duplicate) / ----•--- ------- This Permit Expires 1 Year From Date Issued: Date Issued l�A__ --c-c- 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 LOCATIO - I � :�lc�--v�/• -----, , Owner's Named +.Co Phone ----------- ---------- -- -•- � _��.,`�.�`'`---------------- Addressr3ti ----------------------- ' Contractor's Name ------------------------------------- -------------------------------------------- ............ Phone----------------------------------- Installation will serve: Residence El--Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __I____ Number of bedrooms -) Number of baths 4--._ Lot size _Z_C.�---11`S Water Supply: Public system ❑ Community system ❑ ' Private ❑ Depth to Water Table '0_0 ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam [❑ Clay ❑ Adobe`E]--7F4_ardpan ❑ Previous Application Made: I I f yes,date----------- -------) No New Construction: Yes R"<o ❑ FHA/VA: Yes ❑ No ❑� TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 240 feet.) Septic Tank: Distance from nearest well----�___._--Distance from foundation-/A--i----------.Material--- J, ___._..__ __- [� No. of compartments: 'Zr' ------------Size_.3_1yS�_. Liquid 6e th--._- __ ,P-0�_� - `�---------- q p �- - ------ CapautY-- I Disposal Field: Distance from nearest well---- ---------Distance from foundation-_-��10-_.r_._.__.Distance to nearest lot Q� Number of lines-------f---------------------- ----Length of each line---pQ------- :---Width of trench—P,_4---0----------------- T rench_--,_4---0------------------ T e of filter material__Q -___.Depth of filter material------�. _�_____.Totai length..__I_a-__`--------------_-_-______. p g ------------f / ...... r- Y -------------- Seepage Pit: Numberof nearest well Distance fr foundation____ ________ ____.Distance to nearest lot line_____,_-_-_ 6 p ( g aterial-------/ _e4-�.Size: Diamete r p r Cesspool: Distance:from nearest well---------#----.._Distance from foundation--------------------Lining material---____------..---_.-__-_----_-_-__ ❑ Size: Diameter------------------ -------------------Depth---- ------ ------ ------------Liquid Capacity---------------------------gals. i ! E kA - - Privy: Distance from nearest well------------------------------------ --------------------- from nearest building 0 ❑ Distance.to'.nearest:lot.line----- - ------------------------------------ - - ------------------------------------------------------------------------------------------ 'R 6m6delinq ---`Remodeling and/or repairing (describe):---- ' ----------•--------•---------•--- - -------------------------- ---------------------• I ------------••----------- --------------------------------------------------------------------------------•------ ------------------ -- ------------------------ ----------------------------------•---------------------------- --------------------------------------------------------------------------------------------------------------------- I - ----------------------------------------------------------------------------------------------------------------------------------------------------------- ----------------------- I hereby certify that I hi ve prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed) ------------ - E ------------------------------------------------- ---- ---------------------------------------- ----------(Owner and/or Contractor) By:_------------ ?------------------------------------------------------------(Title) (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY --------------------------------- DATE.... I-1 JZ REVIEWED BY 4 - ----------------------------------------- DATE------ ----- -------------------------------------- - -- -- ---------------------- BUILDING PERMIT ISSUED---------------------------------------------------- --- ----` ` DATE._:------------; Alterations and/or recommen dations:__1.1_:.x- _Jib _._____.__._)S 0---_-_._�4F__ it- E C ------------------------------------------------------.----- `� f .•- � a -------------------------------------------------------------- --------------------------------------------------- --------- -------------------- - --------------------- ------------------------------------------------- ---------------------------------- ------------------------ FINAL INSPECTION BY:---- - ---- Date...... SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 F,Maxelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California r.P.r:a.