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FOR OFFICE USE: ' L < A111ICATION FOR SANITATION PERMIT Permit No. . ............. .. --------------------------- --------------------------- (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 N 549. X f ------------------ JOB ADDRESS AND LOCATION------ /+ Owner's Name------------------- -------- _/-C -Y-. 7.h/ (� -c-------------._...----------- -------- Address----._---------_--------- ---------------- TcJ�--------------.------------------------------------------ ' Contractor's Name---------- y r l ------Z;Y: �---------------------------------------------------------- Phone_"1'4�i��47._. Installation will serve: Residence [g' Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _ ..-_-Number of bedrooms _Z�._ Number of baths _/____ Lot size ------ ms ' s - ----------------- Water Supply: Public system ❑ Community system ❑ Private gr-"Depth to Water Table /-eft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay [5- Adobe ❑ Hardpan ❑ Previous Application Made: (If yes;idate---------------- --) No ['INew Construction: Yes ❑ No ET--FHA/VA: Yes ❑ No ❑---- TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) a L i. Septic T k: Distance from nearest well_c ._____Distance from foundationf.�__-___-,Material-._ _-__________ ` No. of compartments-_____- ._._Size_ _X_ey_�J___.___Li a-rd de t�h-- �__-_--_F�_ -.-Ca aclt r �_�� _. I �:--- -- � q P. P Y--•-------- Disposal Feld:. Distance from nearest well.__��._____Distance from foundation__ - -_-...Distance to nearest lot li`ne____,_r Number of lines-----_- - ------.--Length of each line---------� -----------.Width of trench.-- -,4 .rte-------------- �) �a I Type of filter material-13- G�Depth of filter material-.��__--.-_ ' g � ��_ :_fl`J stance tohne�e5st`� line ��-�� Seepage it: Distance to nearest well__,A __.. ? Distance fr9m foundation............. 1411, Number of pits -,,g-----------Lining material___5e- 1L� ize: Diameter-_Ar�_Iv's'.`�-- ----Depth--,, -------- s Cesspool- Distance from nearest well------------------Distance from foundation------------_---- Lining material-..___--_-------------------------- t ❑ Size: 'Diameter-------------------------------- --De th--•---------------------- - ------------Li Liquid Ca ac;t Y-------- � - ---------gal s Privy: Distance from nearest well----------_----------------------------_---------Distance from nearest building----------._.--------____________...__{- ❑ Distance to nearest lot line--------------------------------------------------- ---------•------------------------------------------------------------------------------- j ~� Remodeling and/or repairing {describe):---__ ..f �SI"J _, /�?`°" G --------� -------------------------- h I = -- ----- ------------------------------- ------------ e ------------------•---------------------------------------- ------------ ---------------------•--•-----------------------------------------•---------------------------- -------------------------- -----------------------------------------------------------=--------•----------------------•------------------------------------------------------------------------------------------• ------------------ ------------ -- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State nd rules and regulations of the San Joaquin Local Health District. � 4� (Signed)--.--------- ----- ------» - � � --- - wne and/o�Contrac`tor) fBY:------------------------ ------- -- � --------------------`=-------------------------------(Title r- ------------- G (Plot plan, showing size of lot, location system in relation to wells, buildings, etc., can be placed on reverse side). } FOR DEPARTMENT USE ONLY I APPLICATION ACCEPTED BY------_V4..1._..--__-_ -._—------------------- ------------------ DATE------ '�// +r ------ "14- REVIEWED BY - - - ---------- ----.. DATE--------------------------------- BUILDINGPERMIT ISSUED------------ -- ---------------- --------------------------------- ------ DATE------------------------------------------------------------- Alterations and/or-recommendation:--------._-. _. ------`-'-`��` /L -- - -- ---- ----- ------------------- - -----•--------------•-------------------------- - -----------I--- Date--------- ,_� ----- -------------- --------------------- -------- --- -•------- •-•--------------------- - -- ------------- ----------------------------- FINAL - ---------------- FINAL INSPECTION BY:-. - / ------------ S N JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haxelton Ave. 30 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California f.P.r O.