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FOR OFFICE USE: --------- APPLICATION FOR SANITATION PERMIT Permit No. __ ....... ------------- -- - (Complete'in Duplicate) � Date Issued This Permit_Expires_I 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 coip�fiance with County Ordinance No. 549. x, pg�_NO --?—O ',-,3 13� 733 �-a rj, E-t i Gur u %rte - - ��` ,i` ' �cr°f ~ /- - ��-------- �-��T------------ JOB ADDRESS AND LOCATION_.> _o� _ __ _ _ -Q•�'� �.- Owner's Name Gt'1lTx► 4�-- --------------------- ---- ------------- Phone------------------------------------ Address Contractor's Name---- Installation will serve: Residence [?' Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __j!_-_ Number of bedrooms _ '�._ Number of baths _1____ Lot size -----/_,�,3_-4�- Water Supply: Public system ❑ Community system ❑ Private Z__-Depth to Water Table _48!�ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ardpan ❑ Previous Application Made: (If yes,date------------------_) No 23"—New Construction: Yes No ❑ FHA/VA: Yes ❑ N0 Pa`__ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest weil-574?___.....Distance from foundation-- _/_0 Material_____ _ _ ------ ____________-_-_____. [1_�_ No. of compartments----�.----------------size----_--X ---Liquid depth---------.'__.---------Capacity__4r4Z?�.___ __ Disposal Field: Distance from nearest weII45-O_...___._Distance from foundation_W---------------Distance to nearest lot line__-5`__`...... 23`— Number of lines--------t-------------------------Length of each line-9A of trench._ _--_--.___---__.--------- Type of filter materia�EVka t--------_-Depth of filter material./$"-"---------------Total length----------Flo ------------------._ i _-D_ Seepage Pit: Distance to nearest well...1490_.__._-- --Distance from foundation_��_p_______--_.Distance to nearest lot line_.��__..._ Number of pits.-.----L____.-------Lining materia 1_77_1?-4A_"Size: Diameter-__3.J_F`....------.Depth....... _.' Cesspool: Distance from nearest well-----------------Distance from foundation------------------- material__.-..--_____.._____.________________ ❑ Size: Diameter----- --------------- ----------------Depth--------------------------------------------- ------Liquid Capacity----------------------------gals.. Privy: Distance from nearest well ___________________________----__ ____________Distance from nearest building..-.-____._____________________.________- } ❑ Distance to nearest lot line------ -------------------------------------- -------------------------------------------------------- --------------------------------------- Remodelingand/or repairing (describe):--------------------- ------------------------------------------------------- --------------------•------------•----•------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ ------- --- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules an re ulations t San oaquin Local Health District. ---. Owner and/or Contractor)ned)-------------------------------------- - -------------------------------------- By:---------------•---•---••-------------------------------------------------------------------------------------------- -------------(Title)---------------------------------------- --- - -- -------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY qq APPLICATION ACCEPTED BY DATE---------- -/------------------------------ REVIEWEDBY------------------------------- -------- --- ---- -------------------------------------------------------------------------- DATE-------"-------------------------- --- BUILDING PERMIT ISSUED------------------------- ---------------------------------- - --r ----- ATE -- --- ---"-------------- Alterations and/or recommendations:_--___ -; ------- ._.._ �--- Lk-----_46-' _i&----------- ---------- ------ ------------------------------------------ FINAL INSPECTION BY:......... ._ ��t > ____ -- Date-----------------t 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.