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FOR OFFICE USE: -------- -- ----------------- --------- No. i s ------ -------------------------- ------------- ----- ------------ APPLICATION FOR SANITATION PERMIT Permit . ..................... (Complete in Duplicate) ..___._._ Date Issued -------- --- � 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 in compliance+with County Ordinance No. 549. 2-5—o—1'f D—0 9 ,, n JOB ADDRESS AND LOCATION..T`_ .- '��`� ---------1 1 t ------- / 7C Owner's Name---------DA-&A-1--G-Q--------- -••-•-4------ E LC ----------- - - --------------------------------------- Phone&'7 j{ Address_-------------------�°---�-9----�-'�-x----7-�-p--_ �-�- _�_�__ ��•/ .!-------------•------------------•------•-------- :.:. t fo&�fao 7 Contractor's Name_..--"-------•---------- /�1�. .I ---- S `� l--�---------------------- ------ Phone . Installation will serve: -Residence ❑ Apartment House ❑ Commercial X Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -------- Number of bedrooms -------- Number of baths -------- Lot size -----ACP __________________ Supply: Public s�stem Community system ❑ Private X Depth to Water Table ft. Watery ❑ Character of soil to a depth of 3 feet: Sand ❑ "Gravel ❑ Sandy Loarn ❑ Clay Loam D( Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date-- } No %L New Construction: Yes ❑ No Y FHA/VA: Yes ❑ NoA i TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well-----------------Distance from foundation--------------------Material__-__-..-._._-.-._._.-..---.________.__--- ❑ No. of compartments-------------------------- Size-_--•---------------------------Liquid depth----- - Capacity _ �, t ... __.. -_ ��--__-.--.Distance to nearest !o# l�nr3__- __...___ j Disposal Field: Distance from nearest well. Distance from foundation. q�� Number of lines-UAkO---�3_trr-_0.---- -_Length of each line----- 1�-------------------Width of trench---- -------------------- N_ Type of filter material------------------------Depth of filtai materi _____________________Total length------------------------------------------ (A Seepage Pit: Distance to nearest well-----__---------------Distance from foundation-------------.------Distance to nearest lot line-----._____--_--_ ]] Number of pits F ------- ------Lining material --- ------ ---.Size: Diameter-------------- --------Depth --•--------- G Cesspool: Distance from nearest well_______..._.__Distance from foundation___.f_-___.-_--.Lining material------------------------------------- �L7 .,Size: Diameter------ Depth ------------------------------------------------Liquid Capacity gals.Privy: Distance from nearest well---------------- Distance from riearest'buildin -___. _-.� ________ ______ _ ❑ Distance to nearest lot line---._ ° } -------------- ' - - ---------------------------------=-------- - Remodeling and/or repairing (describe):__ .. _ _ -------- - - ------ ---- ------------ ------t - - -------------------------------------- ----------------------- -------- ---------------------------- r: e - ------------------------- ----� ------------------------------------------------------- --- --- f I hereby certify that I have 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, I I 41_�� --j__________________________ Owner and or Contractor(Signed}---------- ------------------g _ c.L -� ---- -------------(T I - - -----------------y•---- ----------•---- ---- --------- (Title) - (Plat plan, showing size o lat, location of system in relation to wells, buildings, etc., can-be plat on reverse side). ; �- FOR DEPARTMENT USE ONLY F t , f APPLICATION ACCEPTED BY---- -- - --- = fir_, - =° - ------------------------------- -------------------- ----------------------------- DATE i REVIEWED BY = ='"T DATE DATE---------------------- BUILDING PERMIT ISSUED----------------- ------------ --- ----------- ----------------------------------------- --------- -- ------------------------ a. ---- ---------------- 1 Alterations acid/or recommendations:._.._ _ --- S �rtS CLI -"------"--"--- fx/ "` Ptp ------------ ------------------------------ �'�rr " -Mean I_ _ .A `-------- -----------------------------------------------------------------•--------- . .—.x / ti ____ ___ ________________________________________________________________ .____- _._._._____..__ ----------------- _.__.._-_- ________________________________________________ M1 _y _-_-_.__t:��A_ - --------- --------------------- ys_. __ . ......----------------------------- - ........................ . ..................---..._._.._..-----____,.----------- F�1 ___- ___.____.__ ._____.. ----------------------_.__- .-..__-_.- . ...... ..-------------------------- 0 _______________________ ______ __�____ 4 _ -..___... __ _ . .-__ . t � F , FINAL INSPECTION BY:. -- - '--- Date-------------- --f_� _. -7-""----------`--------------------------- J DISTRICT UIN,LOCAt HEALTH t Q 1801 E.HaYslton Ave. 300 West Oak Street Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.E o.