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FOR OFFICE USE: l -- -- J__-A'OPLICATIO! ''1=0R SANITATION PERMIT Permit No. /_5___ -4" ---------------- --- ..------------------_--. ------ (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 work herein described. This application is made in compliance with �/OiD_ Tw ty Ordinance No. 549. Q JOS ADDRESS AND LOCATION__-3- r1L�_ __ --------- -------•-•-----------------------•---•--••------------------------- -------- n Owner's Name.__ 1Q - � =----- --------- -------------------------------------------Phone_ �1 Address t-AQ----F,,. ��_Vt�---------------------------------------------------------------------- Contractor's Name-------.11% } ------------------------•-------------------------------------------------------------•-------------------------------- Phone------------•-•.................... Installation will serve: Residence 9 Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __�.___ Number of bedrooms _ ._ Number of baths �_..._ Lot size -___55 _.j;;L!S__________________________________ Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table --- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam•❑ Clay ❑ Adobe, Hardpan ❑ I , Previous Application Made: (If yes,date------.-_-_,........) No ❑ New Construction: Yes ❑ No t< FHA/VA: Yes ❑ No ❑ 4 ` TYPE OF INSTA LATION AND SPECIFICATIONS: _V (No Sep tank or cesspool permitted if public sewer is available within 200 feet.) Septic Distance from nearest well_________________Distance from foundation--------------------Material ___-__.______...__.____-.__________-_-._._____. $� No. of compartments--------------------------Size-------•-----------------------•Liquid epth...__---------- --------Capacity-••-------------------- ; Disposal Field: Distance from nearesLwell_�JI�-------Distance from foundation______.__...__.Distance to nearest lot line____-15..----.. r a A, Number of lines_________ ------------------------Length of each line--------'L(?__/�_..______.Width of trench....__ .____,__.____.__.______-__ Type of filter material.S�__.Q4t<__Depth of filter material-----Zg _-_..----Total length_------�._Of 1 6/ See istance to nearest well.._ ______-__Distance from foundation__ _____.___.Dis ante to nearest lot line__.______.__..._ ` Number of its-------I------ 4M-61---De ' `Q -------- Cesspool: ---- i � p - ____Lining matenal��_.�K__Size: Diameter___ Depth _ _. _._ Cesspool: Distance from nearest well-----____________Distance from foundation._.-----_---------_.Lining material___----------------.______._________ ❑ Size: Diameter----------- --------------Depth------=------------------- --- ---------------------Liquid Capacity---------------------------•.gals. Privy: Distance from nearest well-------------------- �1 ____-._.___________________Distance from nearest building______-___._____.________ ❑ Distance to nearest lot line- ------------------------------------------- Remodeling --------------------•---------------- Remodeling and/or repairing (describe) --------------- -------------•- -----------------------------------------------------------------••------------------------------- -----•---------------- -----•-----------•--------------------------- ------------------------------------------------------------------------------------ ----- ----------------------------------------------- ------ ------------------------------------- --•------------------------------------------------------------------------------------------------------•------------------------------------------------------------------------- ------------------- ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- I ---•-----------------------------------------------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. (Signed - 1_e --------------------------------- (Owner and/or Contractor) By=---------------- (r+le� -------------- ----------------------------- ---------------------- ------- -------- ----- - ------ ------ (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------------------ ---- REVIEWEDBY--------------------------- ---- -- ---------------------------------------- ----------------------------------------------- DATE_ ----------- BUILDING PERMIT ISSUED-------------------------------------- ---D ------- -- -- ---- --- Alterations and/or re en ti S. r ---------- ---------------- ----- _ �1/------ - ------- - ------- �- s / ------ - ---- E: ----- --- _ -=------------ ,/� es_ ` 64A 4 64' FINAL INSPECTION SY:------ --- -------------------- ----------- -- --------- - ate---....- - --•/�-�`�r✓ SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. f• v .300 West Oak Street r 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Mantecar California Tracy,California F.P.CO. rL i I