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FOR OFFICE USE- ---------------- ----------- -------- SE:..____ _______________ ___----------------- ------------- APPLICATION FOR SANITATION PERMIT Permit No. ._1 422..._ -------------------------------- --- --------------- (Complete in Duplicate) ...... _.._f This Permit Expires 1 Year From Date Issued Date Issued _1065..._. 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 ini.compliance with County Ordinance No. 549, JOB ADDRESS AND CATION_____ _ ___ -_�Rh_X ----------------------- iv---------------------------------------------------------------------- Owner's Name >�ll�l`lL/1 h_/' (Z �0 ------- °------------------------------ -------------- Phone-----•--••-•-----------•------------ Address---------------------------- Yr .- - ----------------- Contractor's Name------------ J L- Phone. ------------------------------------- - s Installation will serve: Residence [tr�Aparfinent House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __Z---Number of:bedrooms _' - Number of baths i_Z._ Lot size _�___/_,� __ _ a'`�______________________ Water Supply: Public system munity system El Private E] Depth to Wafter Table'T_7ft. 4: Character of soil to a depth of 3 feet: Sand Ep Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ET-�R`ardpan ❑ r Previous Application Made: (If yes,dote_________ ----______) No P9-'-17ew Construction: Yes [? P o❑ FHA/VA: Yes 0 Nom' TYPE OF INSTALLATION AND SPECIFICATIONS: (Noseptictank or cesspool permitted if:public sewer•_is_arailable within 200 feet.) Septic Tan Distance from nearest well_-:h::__---_Distance from foundation I ��Q a®_ Mat �al ----------- ----.-_'Size___ l��-----Liquid depth__.___ ______Ca Capacity- Q � N OZ No. of.compartments__ ..__. f` Disposal Field- Distance from nearest weefl -"'_'_____'Distance from foundation---/a�.__Distance to nearest lot line__S_.--�__.. p 77 Number of lines____________ f Length of each line______-_© v----t-_. -_-__._.Width of trench -. ..,. Type of filter material__1y4g,.. _2Depth of filter material__ .��________7ofiald____.�f QQ-- Seepage P' • Distance to nearest well!= ------'Distance from f undation____/��-_. Distance to nearest lot line- f ❑ Number of pits--------7�-......Lining material-__--� �� ..-. .---Size: Diameter-- �'-----------Depth-----.--Z),4T..... Cesspool: Distance from nearest well--------------_?.Distance from foundation.}___--. _..Lining well R_y" tematerial-____ _______..__------_______.._.. Size: Diameter_________________ ________ ' Depth------------------------------ ----------------------- Capacity----------------------------gals. Privy Distance from nearest Distance from nearest building-_ ❑ Distance to nearest lot line-_ e ------------------------------------- "7 Remodeling and/or repairing (describe):----$-----____ ____ ------- - -- - - - ' ---------------------••---•----------------•-------------------------------------- r ----------------------------- --------------- ----------- - F I hereby certify that I have prepared this application�e--'P�-the-work will 'tie done in accordance with San Joaquin County i ordinances, State laws, and rules and regulations a Saind-tF�tin Local Health District. [n Joa, (Signed)------------------------------------------ - --- ----- --- ------- ----- ---- ---'--------- ------------------------------ --- ----.[Owner andiQontractor] ' BY: ------ --- - -- - -----------(Title)------ [Piot plan, showing size of lot, locafia system in relation to wells, but gs, etc., cari be placed on reverse side]. FOR DEPARTME T USE ONLY APPLICATION ACCEPTED. BY. - -.........- ✓ ----------------- DATE------ ' REVIEWED BY --- ---- !'`: D1ATE BUILDING PERMIT ISSUED--------------------- t DATE------ ----------- -- - ----- - - ------------------------------------- Alterations and/or recommendations:._____ / --------------- --- --------------------------------------------------•------------- -------------------------- F1 NAL -------------FINAL INSPECTION - -- Date........ - s _ ------ j SAN JO IN LOCAL HEALTH DISTRICT I . 1601 E.Hazelton Are"i 300 West Oak Streett 724 Sycamore Street 205 West 9th Street Stockton,California Lodi,CaliforniaManteca,California Tracy,California I F.01