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FOR OFFICE USE: Rr - ----------------- Permit No. .��`. �- ---- J APPLICATION FOR SANITATION PERMIT . ------ -------- --------- --------- ----------- (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 i? tru<ct an (tall 3oor erein described. ti-Yn This application is made in compliance with County Ordina ce No. 549. J r0 7 Y Sri r 6'"T e-r f t-af A4 7 t �` JOB ADDRESS AND LOCATION...: '� ---if - < Q ----- c iltty `' Owner's Name------ � '� � •---------------------- --------------------- Phone--------------- -------------------- \\\ ----------------------------------------- Addres�s_---'-------- cII� I ------ ..!1_[�. �.�.?s--------•-------------- -------------- Contractors Name------------�_ •-----. ------. �'� - ----._ ----------. Phone Installation will serve: Residencepartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ 1� Number of living units: --/.- Nuritber of bedrooms .- Number of baths Lot size ._- .__ .. 1 r 3Z------ Water Supply: Public system ❑ Community system ❑ Private �pth to Water Table _6�ft. Loam Cla Loam Cla ❑ Adobe ardpan Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sand - Lo ❑ y ❑ Y FHA/VA: Yes P-- No [ Previous Application Made: (If yes,date-.-•- - ----------) No New Construction: Yes [A- o ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic 7a Distance from nearest we __ p__�__-Distance from foundation---�[_-0-_--__.Material.f. .-_-_ ©/ No. of compartments-----r - Size- - -�=-- ,Y_3__Liquid depth------ ..-�--I------Capacity-�-- �---- ��--yy j, t ' Disposal Field: Distance from nearest well-_?l 0-j-_-Distance from foundation---- Distance to nearest lot line _ / Length of each line----._y_ ;V75---.Width of trench----s�'/.__f______--_____._ Number of lines------ _.__ _--- g /-� --- j © Type of filter material__=�_/x��l __�.___Depth of filter material----�_ r�__----_Total length__,11 L p nn �__..Distanee to nearest lot line__.a� of--- l�. Seepage pit: Distance to nearest well---�..L`_4•:_-------Distance fr fo ndetion__� � Ll Q� Number of pits---__* -- --Lining material__----" _'_�..-- Size: Diameter_ __ ___ ________Depth__.r r�--.•'�-.----- Cesspool: Distance from nearest well ----------------Distance from foundation..------------------Lining material___.-------._----__.___----_____.--- ❑ Size: Diameter- --- --------- ----- r---------------Depth---------------------------- --------- ------------Liquid Capacity----------------------------gals, Privy: Distance from nearest well---------------------------------------------- --Distance frorn3nearest building-___. ------------------------------ Distance ❑ Distance to nearest lot line - --- _- -------------------------.; - ---- ------------------------------------------- -------------------------------------------- f J Remodeling and/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, fa a ws, and rules a d re at n f the San Joaquin Local Health District. ---------------------------------- --------- (Owner and/or Contractor) ---------_-- (Signed) - -- -- ---- --------- B �- � 1-- -------------------------------------(Title)----- (Plot plan, showing siz:410 , location of system in relation to wit e Is, b'utidings; etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY- ___4-X- i'1. 1. -----�� DATE----- � y ------------------ REVIEWEDBY--------------------------------- - ---- DATE------------ -------------------------------------- ------ BUILDINGPERMIT ISSUED-------------------------------------------------------t----- - ------ DATE------------------------------------------------------------- Alterations and/or recommendations--------------------- -------------------------------------- -------------- --••----------- ---------- --------------- --------------------- -------------------------------------- -- ------------------ FINAL INSPECTION BY:------gip` . Date.- - ------- --------------------- ------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hasellon Ave. 300 West Oak Street 124 Sycamofe Street 205 West 9Th Street Stockton,California Lodi,California Mantecb,California Tracy,California F.P.C C.