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FOR OFFICE USE: .z _______________________ _'------._-_ ___ ___- ___-- --- APPLICATiON FOR SANITATION PERMIT Permit No. l�_A/ _____ -------- (Complete in Duplicate) p� - This Permit Ex ires 1 Yedr;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. ThiAs j�[application is made �i.n�^compliance with County Ordinance No. 549. _ "/J . 1-7-3-- r`L2 -f 11 fo JOB ADDRESS AND LOCATION_fY -.-14-7 � " __.Q `_(c.. -___ Owner's Name __:/ --- -�- � r--_--`--- -------------- � - ; -- -------------------------- - -------..._ Phone--------------- Address....... -------------Address----... 041 - Contractor's Name-------- -------------------9 -------- `A........ 1 ------ Phone----------------•---__--------- Installation will serve: Residence [�artment House ❑ Conimercial El Trailer Court E] Motel [] Other ❑ I � { _ � oe Number of living units: - _ Number of bedrooms _. _ Numb'e'r of baths _ __ Lot size _f7 X--.9�________________________________+' ` / f � Water Supply: Public system Community system ❑ Private E] Depth to Wa er Table 40 ft. 4 _ Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy{Loam ❑ Clay Loam ❑ Clay ❑ A�lobe M—gardpan Previous Application.Made:,_(If,yes„date------------------::==y cNo. New Construction: Yes - 'No E]- FWA%VA: Yes g4-'NoEl TYPE OF INSTALLATION AND SPECIFICATIONS: D (No septic .tank or cesspool permitted if public sjw,er'is available within 200 feet.) �------Matial-j__f' �_Q Septic Tank: Distance from nearest well------ -__�__Distance from faundation__� No. of compartments-__A ., Liquid de th--- i Ca acit ____ I Size __. ._ e Disposal Field: i Distance from nearest w0.___77—____ Distance frog foundaf n---Z�_�___-Distance to nearest lot line__��_._____ [ � Number.of fines------ ___--- _,Length of each line__-- -- ------------ --Width of trench_ _"------------------------- t Type of filter material_! ;Depth of filter krnaferi,l---- ___'_-.Total length__ __ _--___-------------------- �` Seepage Pit: Distance to nearest well------ -------Distance from foundation---ef --------Distance to nearest lot Ii e___________ Number of pits------l__._.-______Lining materialSize: Diameter_JU--.-__...___Depth_4'�_____ ' Cesspool' DistaiAce from,'wrest well-___________ __Distance from foundation---------------------Lining material-----.-------------.___--_--_-___--- ❑ Size: Diameter--------- ---------------------------Depth------------------ "= - - ---- '-x-,----------Liquid CapadtY- -------- ----- %----------------gals. � PPrivy: Distance from.-'earest building_________________ riv Distance from nearest well________________________--__.___-.------ -.- � _--=_a_'"�-----__---. ❑ Distance to nearest Int line_------------------------- N------------------------------------------------------------------------)------ ------------------------------- Remodeling and/or repairing '{describe):)------- 54 --i-----------------------i--------------------------------------- ---- ----------------- - --'-- ---___- b --------------_-'- — ' --..., -- --------- ------------- ----------- ---- ----- -- -------------------------------------- ---------------- ----------- --- ----- --- -- -- -- , zeo 61Q Gl ee----------------� �'�l�-”----- '- ------------------ -- � �.�.. :. �?° ---`_ �`=----------- --------- ---------------- r� I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State Iws, and rules and regulations of the San Joaquin Local Health District. (Signed)-------------------= -1,-6-r --- -- ------------------------------------------------------ Contractor) B (Title)---- � --------------------------- ------- (Plot plan, showing size of lot, location of syste relation to wells, buildings, etc., can be placed on reverse side). t ( � FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----- - - -- C� ------------------- -- -------------------------------------------- DATE- `rJ s(/47------------------------- REVIEWED BY--------I------------------------------------ --------------------------------- ------- -------------------------------------- DATE----1------------- ----- ------------------------------------ BUILDING PERMIT, ISSUED - - ---------- DATE Alterations and/orirecommendations / -------- �----- I> -------------------------------- ----------------- ---------- --- -- --=------------ -------------- - ---------------- -- ew l -------------------------------------------------------------------=-------------- --------- -------------------------------------- ----------------------- ---------� ------------- -------------------------------------- FINAL INSPECTION BY:------ .......... - ----- .--- - Date------------- r:l SAN JOAQUIN FLOCAL HEALTH DISTRICT 1401 E.Hazelton Ave. 300 West Oak Street N i�,124 Sycamore Street 205 West 9th Street S S i Stockton,California Lodi,California _ Manteca,California Tracy,California F.P.CC.