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�R OFFICE, USE: !3 APPLICATION FOR SANITATION PERMIT a4_� L --------- -- Permit No. . . - , - .`' (Complete in Duplicate) . E-... Date Issued ---------------------------.--- This Permit Expires 1 Year From Date Issued ' Application is hereby made to the San Joaquin Local Healfh District for a permit to construct and install a work here°n des ibed. This application is made in.compliance with County Ordinance No. 549. � �,�. fps'--/Ota-v+� /; JOBADDRESSAND LOCATION__�' 1 �r^�`' Vf----le. _ p a gex vl I Owner's Name % fi -------------------------- Phone ' -----------',�'"""------�x -------"---- ------ --------------------------------------------------------------- i Address__ .__�' . Contractor's Name---------- , �-t"D / ---------------------------- ---------------- Phone. ..._..... Installation will serve: Resideffce partment�F{ouse�❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other [I ` Number of living units: --4-- Number of bedroofis orL Num er of baths _/-_ Lot size _ /. N-----------------•--- Water Supply: Public system E] Community syste� _ Private Depth to Water Table495;✓ ft Character of soil to a depth of 3 feet: Sand ❑ . Gravel ❑ Sandy Loam Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date____________________1 No New Construction: Yes [:] No ®^ FHA/VA: Yes ❑ No �- ,. TYPE OF INSTALLATION AND SPECIFICATIONS: t i ' (No septic tank or cesspool permitted if public sewer ii available within 200 feet.) � --------- ---------- Mat riai we - Septic Tank: Distance'from nearest well__4Distance from foundation___ __ ___ _ rn� No. of compartments_.-A------------------Size *��--" 3X• _-_Liquid depth__� --___.__---._Capacity��p%o- " Disposal Field: Qisfance from nearest well_�A_-.....Distance from foundation__ _-_Q.__._.__.Distance to nearest lot line __"'_______. Number of lines___¢__ ______ Length�of_,each line_ i �� Width of•trench-,Z --------------"----------- T e of filter material2 Depth of filter material_._`---_-_""-- Total length_! --------------------------- iC � yp � / Seepage Pit: Distance to-neares`t�weli__f��----Distance from fo ndation__�X� __.Distannce toynearest t e__tf'_._.._. Number of pits .___----Lining material_, ejfgg ---Size:.,Diameter__S.F.............Depfhv2 Cesspool: Distance from nearest°well-________________Distance from foundation_-----------------Lining material ..._____.______.__._-______._-_-__. ❑ Size: Diameter------------- - ---------------De,oth--------------------------------------- --------Liquid Capacity----- I------------------gals. Privy. Distance from nearest well-__--------------------------- t _...Distance from nearest building--------------__-__._______---._•_.-_-. ❑ - .�- - •-------------- Distance to nearest lot line �---------_°='.'"------ ----------------------------------- -- -�---------"------�------------- • --------------- Remodeling and/or repairing (describe)_----------------------------------------- _____________ 'l '�/F��r % f� � r ------------------------------------------•----------------------------- ------- - ----------- -------------------------------------------------------------------------------------------------- --------------------j_-•--•----------------------------•------------------ 1 hereby certify that I have prepared this application and that,the work will be done in accordance with San Joaquin County ordinance$, State laws, and rules and regulations of the San Joaquin Local Health District. # 9or Contractor) (Signed) --( �. F'-'---------f - Title-----4019w•------------------------------------------------- f (Title) � -� - (Plot plan, showing size of lot, location of system in r ion to wells, buildings, etc:, can be placed an reverse side). FOR DEPARTMENT USE ONLY / o ' APPLICATION ACCEPTED BY---.------- C =Y -- ---- DATE.---- ��f ��------------- REVIEWEDBY------------- ----------------- ----- DATE------------------------------ + eC�c' f !� (n."' C--.. c_m_c,- LL��—r"A• `� DATE A, EBUILDING PERMIT ISSUED--------------- --------------------------------r--------- --------------------------------------------- --o ,c { �-4 a C -� C i �`"Alterations and/or recommendations: - - 1 -• c - � � __ -------------------- ----------------------------- ------L_c _ - -------------- ---------------------- --- -------------------------------- ------ ----------------------- -•------------ -------------------------- ----- FINAL INSPECTION BY:----`"-` /* ----------------- -- Date.... SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Ha:elion Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California *: Manteca,California s+s-x, Tracy,California 4 F.P.C3.