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FOR OFFICE USE: ----=------ --------------------------- ------------------------- ----------------- --: - APPLICATION FOR SANITATION PERMIT Permit No. - (Complete in Duplicate) Date issued - _- � ----------------------------- ------- -------- This Permit Expires t Year From Date Issued Application is hereby r>iade to the San Joaquin Local Health District for a permit to construct and install a work herein described. This application is ma'Je incompliance with County Ordinance o. 549. p qlt t !I '� JOB ADDRESS AND LOCATIONGr�i'� . _--- -- 4CQ----- 4_27 ---------------------------- Phone Name-------- - - ---- TG Address------------------------.6-adV...... = _.1/ aT�� Contractor's Name---" 1, 51 .---G — ---------------------------- 1 -------------------------- PhonelP I, Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ 'Trailer Court ❑ Motel ❑ Other ❑ Number of living units:)---I-_ Number of bedrooms ---/__ Number of baths __CkA'Lot> e ------.--------------- - f------------------- Water Supply: Public system El Community system ❑ Private, Depth to Water%Tlable -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay E Adobe ❑ Hardpan Previous Application Made: (If yes,date--:------------------------ No IP-'New Construction: Yes ❑ No 2 FHA/VA; Yes ❑ No L5-- TYPE.OF INSTALLATION AND SPECIFICATIONS: {No septic tank or cesspool�permi}tedrlf_purblic a�er�is av ailabfe ith 200 feet.] " ' Septic Tank: Distance from nearest well._ C9------Distance`from fou�nd,ation 40-/_----..Material__ -------- ---------- ------- No. of compartments------#?P=----------:Size ---Liquid de th__.'� _.-r___.__Capacity--d- ---------- Disposal Field: _ _ ____Dis oalField: Distance from nearest we _ "..._D-stance � I fr&n1foundation._�e_/-_--_-..Distance to nearest lot line--_---57 ®� Number of lines-----__-'y....-/._..---_---Length of each line-_g __". --...Width of trench----- '_-_.`.------- Type of filter material____ _ 1?�k--Depth of filter material_f�"..------.Total length--- -----------------__--_. 1 i � See a e it: hlumberoo nearest well_-l.._O_.........Distance fro foundation___lQ____ .__..Distance to nearest lot line_________________ � p 9 fpits---------------Lining material--� Sizer Diameter----__1k3-........---Depth -25-!�-------------- p I Cess ool: Distance from nearest well Distance from.foundation....................Lining material--.-.-_-----__------.-----_---_---._. El Size: Darneter--------------------------------------De th_..--------------------------- ---------------Liquid Capacity gals, Privy: Distance from nearest well---_-----------------------------------------;--Distance from nearest building-..-----_..--.----_-----_-_-_-__._.----.. ❑ Distance to nearest lot line-------- --------------------------- y Remodeling and/or repairing.''describe :...._ GCJ ' ------------------------------------- 1I 1 . ---------------------•- -----ti- 1_ �; ------------------------------------------ A---- --------- ------•-•------------------------------------ ------------------------ ---------- -----------------------------------------=--------------------------------------------------------------------- ---------------------------------- ------------------------------ I hereby certify that I have prepared this application and,+ the work will be done in accordance with San Joaquin County ordinances, State,,", d rules and regulations of + San oaquin Local Health District. -�? A AAs/ �y -- --50, &;nn (Signed)-- - -¢- �' e nd/or Contractor] - gy = true . a (Plot plan, showing size of lot,,112 ion of system in relation to wells, buildings, etc., can be placed on reverse side). ii FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY:__4?� __- ____________________________ REVIEWEDBY ------------°= ------------------------------------------------------ ------------------------------------- DATE-- BUILDING PERMIT ISSUED-___ --------------------------------------------------------------------------------- ------------- DATE----------------------------- Alterations and/or recommendations:------- _--- ---------------------------------------------------=------------------------------=------------------------------- --------------•------------- - r u •----------------------------------- - - ----------------------------------- % } = --------'-----------------'--- ------------------------------------- ------ ------------------------------------------------------ i t I' w FINAL INSPECTION BY ---------- , Y SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F,RCO-