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FOR OFFICE USE: — ---------------- - -- --------------------------------------------- --------- APPLICATION FOR SANITATION PERMIT Permit No. _;P.4.7. ... �) ------------ ---- ----------------------- ------------- (Complete in Duplicate) _�_=/_-:.f✓.� ---,----------------------------------_.-..-:------------- 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 nstali the work herein described. This application is made in compliance with County Ordinance No. S49. /� 1137 JOB ADDRESS AND LOC TION I6-- - - --- /---f 'L '"V"r�' ------------- - --` Owner's Name-c- �'' _ , �(�`�----------- Address " L•�L l ,fes' `-- _._ -`--/ � --- - �- Phon Address-------9-6--/4-- - - yn-------------------------------------------------------------------------------------------------------------------------------------------------- t Contractor's Name-- -- ----- -- ---- --- ----� -S.-•-------�-------------------------------------------------------------- ------------•--- Phone.---••--....---•------•----------.. Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ ffMotpl E] Other Number of living units: -------- Number of bedrooms -------- Number of baths 12--- Lot size ___4_ _ _fT,0-------•------------------• Water Supply: Public systemCommunity system ❑ Private ❑ Depth to Water Table ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sa y Loam Clay Loam ❑ Clay E] Adobe Hardpan El Previous Application Made: {if yes,date-..._____..--------) No FNew E]Construction: Yes g?-N' , ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Ta Distance from nearest well______"_-_.__Distance from foundation_/ __f.-_..-- MatefriaL_I�l E _.___...______- �E No. of compartments-.-,.,-_______________Size___,:--- �-�!r-`Liquid depth__.'___._..-- Capacity__�5!f� �� Disposal os—al Field: aell- - -Distance rom line foundation-46 Distance th esinh_ . ----- Number __Numberr of Ines.- -/ -------- ---- Length of each �________-Widthoftrenc �-1 - -- �Type of flier mate riar-1��1-----_____Depthlength �i of filter material-______________________Total length-_-._--.---_________-____________ __.__._ Seepa . Pit: Distance to nearest well .__—-------Distance from foundation_A0. ........ Distance to nearest lot line�--------- �1 Number of pits------_-------------Lining mate ria l__?i7G._*f-------Size: Diameter--.3.1".--------Depth----.--- ------ i Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining 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 1 have prepared this application and that the work will be done in accordance with San Joaquin County V ordinances, State I , 'and rules an re ulatio s of the San Joaquin Local Health District. - --- -- --------------- ------------ ---------------- --- ---------------------- (Owner and/or Contractor) (Signed) By:---------------------F-------------------- -------------------------- ----------------------------------..--------------------------(Title).......... ----------------- ----------- - - -....- (Plot plan, showing size of loft, location of system in relation to wells, buildings, etc., can 6e placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---- _ - -- -------------------------------------------------------- DATE / -------------------------- _' REVIEWEDBY---------------'----------------- - -- - - - -----------------------------------------------------•-------------------- DATE----------------------------------------------------------- BUILDING PERMIT ISSUED----------- f- C�xii� DATE - - -------- ---- ----------------------- At on and or recommendations:___ ttl i ....__ g rtl►.�___ l r ------cJ ------- f ------ r1 �----- _________ _____ _ __________ _ ------ -- ----------------------------------�________________.....__.__--_.--------._.__.___.___________..._-.____-__----_____.________._/ --------- _.____..__..___. ________-------- =arc - ---1 ---------f- ------ t - ------------------------------- - ----- -- --------- ! rr f/ /ylj� KCAALTH / j� / e-- {�A", �FR�7AL INSPECTI6 BY: ---- - --- ------- -- Date---SAN JOAQ DISTRICT 1601 E.Harellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ,