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--FOR CCE-IfSE: -- J-- ------------ �I,a.0_ , ............ .....£_- ...---------.- APPLICATION FOR SANITATION PERMIT Permit No. �� j (Complete in Duplicate) ------------------ ------------------------------------- ,. i ............................................:............ 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 work herein described. This application is made in compliance with County Ordinance No. 549. ) t JOB ADDRESS AND LOCATION. ' - -��-r `��:f.�K�=_ --- -------_---------------- rr Owner's Name------- ------ �'�, ---------- -------------•------- --- ---- ------ Phone.-•------....---------...#--------- IAddress-----•------ ,� ,�.- jp_ • _Au�s_,c-X__,A�----- Contractor t J �-�/4 �f------------------ ---- Contractor's Name-------- - ------- ---�--.----- .- Installation will serve: Residence [ Apartment House ❑ Comme'rcial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _j-_._ Number of bedrooms Number of baths __/--- Lot size ---____-__--------------- Water Supply: Public system ['Community system ❑ Private ❑ Depth to Water Table -6 eft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Cl)y ❑ Adobe 0' Hardpan ❑ Previous Application Made: (If yes,date____________________) No [ New Construction: Yes ❑ No [g_—FHA/VA: Yes ❑ No K;— TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is availa6le within 200 feet.) i Septic Tan Distance from nearest well-----------------Distance from foundation--------------------Material---._------ --------------_-----____._.----_---. No. of compartments--------------------------Size--------------------------------Liquid depth--------- ......... ----Capacity...-------------------- Disposai eld: Distance from nearest well__nlfl-------Distance from foundation_Z_,cD__". ......Distance to nearest lot line_-,e:......_.... U �- Number of lines----------/----------------------Length of each line-----I-A- of trench-----Z_._/-----------'---------- Type of filter material____R6.G__!f_.___Depth of filter materiai____L '_�`.__-_Total.) length...... -____--.- {p Seepage Pit: Distance to nearest well_---IVD-----._.___Distan ndationA__/__a__�______.Distence to nearest lot line_ --'----.-_-_ 0__� Number of pits..____/------------Lining ma rial___1.�a_ �_..__.Size:!Diameter. ._'.Z. _�_Depth-_ > ------------- �f Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lin ing material____._.______ ..-------------- ' Size: Diameter---- ---------------------------------De th------------------------------A--------------------Liquid Capacity gals. Privy: Distance from nearest well--------_----------------_-----------------------Distance from nearest ,wilding:--.-.-._.._____.______-_---__-_.-.-_--... ❑ Distance to nearest:lot Gne---------------- ----------------------------------------------------------------------- --------------------- Remodeling and/or repairin ( le ): � �elele_qzw ._a��C ma 6--- --f----------------- ---------------------___.------------------ ------------ -.-- a - - -- -- -- - - --------------- --------- I hereby certify that I have prepared this application and that the work will bedone in acc rvdance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. f (Signed) , } c_ 1} (Owner and/or Contractor) By:-------- ---- ---------------------------------------------------------------------- - ----------- -(Title)--------it----------------- - --- ----- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placedon reverse side). 4 FOR DEPARTMENT USE ONLY " ] APPLICATION ACCEPTED BY----------------�.- - ----------------------------------------51 ---------_--------- l ------------- DATE---- = REVIEWEDBY----------------------------------- --------- ---`-----= --------------- ---- -•--• DATE----- A PERMIT ISSUED--------------------------------------------- - - ,.---------------- ----- DATE----- i]----------- /Alte> tions an amort rle ommen-----ns� ------------------------------------- ------------------------------;-------- ---------•----•-•#----------------------------------------------------- ----------------------------------------------- ----------------------------------------•--- ------------------------------------------------------------------------------------------------------------------------------- ------------------------- -------- w I FINAL INSPECTION BY................. ------------------------------- ---------- Date---------M-------�4-------�---- --------- ------- -------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Nazellon Av&, 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy, California I F.P.CO.