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r �OR OFFICE USE: 4----------------------------- APPLICATION FOV SANITATION PERMIT Permit No. ...... --------------------- �`_ " (Complete in Duplicate) ___________________ This Permit Expires 1 Year From Date Issued Date Issued Application is hereby made to the San Joaquin Local Health District for a Permit to construct and install the work herelp described. This application is made in compliance with County Ordinance No. 549. /f� 1 O.-1 17—O `r-3 4`ASO ICv7 Id t + / �T p a T JOB ADDRESS V �OCATIION--- � i s ll ¢_ AFD----5Z--y -------Qfi---- ��- 'r,0 Owner's Name � '�-e�l-C__. Q�1--/ IQ --------------- --- Phone------------------------------------ Address------------------�---- -----------------------p------- ------------- •-------- ----------•----------- ------ ----------------- --------------------------------------------------- 1?&_f Namei ?&_f�' lLrl 4�'+ --------------- Phone----------------------------------- Installation will serve- Residence [Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _- -- Number of bedrooms _S__ Number of baths _,'Z- Lot size �__��.� _'____----------------------------- Water Supply: Public system [I Community system El Private 9 /hepth to Water Table , ft Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy loam ❑ Clay Loam ❑ Clay ❑ Adobe 93/Hardpan ❑ Previous Application Made: [if yes,date--------------------) No P-' New Construction: Yes V?- No ❑ FHA/VA: Yes [Z- No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) / Septic Tank: £ Distance from nearest well _* �0._fDistance rom fwndatk----14 ......Material--- _t _. .t f _____________ _ oS��C� �l .Capacity/2"...-----_ I [�' No. of compartments Size .Liquid depth Disposal Field: Distance from neares well._LP49.-.. Distance from foundatiRn___- ___._.Distance to nearest lot line__+�r�____. Number of lines-_---- _--._ __-_ Length of each line_-___/---------------Width of trench..X...-_- ._- _-____.__ Type of filter material-/ A,. of filter material---lep--------Total length ---t"7_ __-._ _-_--Distance from fo ndation____�_---___.Distance to nearest lot Ike- Seepage Pit' Distance to nearest well___141P---- ..__._.._ [(� Number of pits---.- .------_--Lining material---,t�0X .-Size: Diameter___3a --------Deptn_a�f�`.. . Cesspool: Distance from nearest well_________________Distance from foundation-------.-----------Lining material------------------------------------- 171 ___.. --_--_--- -___❑ Size: Diameter--------------------------------------Depth-------------------------------------------------_Liqui.d Capacity------------------------_-gals. Privy: Distance from nearest well---------------------------------_---------------Distance from nearest building____._.------------_____-__-_____...___._. ❑ Distance to nearest lot line----------------------------- - ----------------------------•------- ----- ------- 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, State laws, and rules and regulations soof�the San Joaquin Local Health District. (Signed)---------------------------------- - - ----------------- ------------------------------- -- Contractor] By----------------------------------------------------------------------------------------- ---------{rtle)------� - --------- (Plot plan, showing size of lot, location of system in relation t wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY- ..... DATE. � ./ V REVIEWEDBY------------------------------------------------------------------------------------------------- --------------------------- DATE------ -------- - ---------------------------------------- BUILDING PERMIT ISSUED-----------------------------------•---------------- ---------------------- _ -t--`---`-�--------"--•�'D`ATE----'-i--6- -----------------------------------u-`-"-`----�----�----- � = y --------------------------------------- Alterations and/or recommendations: ` - ------ -------------------------------- �-_ T 1 Gs r ----- --- '= �. _ - ti_=.......--- Date----- -� - Z -- FINAL INSPECTION BY:----- - - -- -- - -------------- --E-�---�-------------------------- SAN - -- -- 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 4t'r�