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7R OFFICE USE: ________ ____ _________ APPLICATION FCR 'SANITATION PERMIT Permit No. -------------------- (Complete in Duplicate) Date Issued ---0-4t4- ---------------------------------------- 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 compliance with County Ordinance No. 549. JOB ADDRESS AND CAT N-------- `'i ......... - -- ------------------------------------------------ -- - -- ------------------------ ~ ; ;p _ Pho� Owner's Name----------- CPA ------•-------- r ..--•-!� -------- ` rte_.. Address............ ---- - -- ------• a , _-- e A-------�---------------------:---------. --------._...-------------- --------- ' 74 I Contractor's Name •L � �`-'!-----... � s---------------------- Phone----�� T� Installation will serve: Residence �artment House ❑ Commercial ❑ Trailer -Court ❑ Motel ❑ Other ❑_ Number of living units: _�__._ Num r of,bedrooms _��fumber of baths _/-_-_ Lot size _-_ �-Q-�__ ._�f_ ________.___ Water Supply: Public system omrnunity system ❑ Privat*4jjgP'07'e`pth to Water Table ________ 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 E] New Construction: Yes ❑ No iA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: 1L11y (No septic tank or cesspool permitted if public sewer is available within 200 feet.) I ptic Distance from nearest wel ._ ___:.___Distance from foundation_/Material------------------------------------------------- l No. of compartments--------I-,-�-------------�Size--------------------------------Liquid depth-------------------------Capacity------ --- ------------ Dis os I Field: Distance from nearest weld !1______Distance from foundat n___�_� __.Distance to nearest I t Ie__ 0____. -'' Number of lines------ Length of each line__ _B__-- --------- CC�r� � ----- ---- ------ -Width of trench--�------------- ------------ Type of filter matercal _Depth of filter material_.__. __ Total length--------.-_6.0--------------------- Seepage Pit: Distance to nearest well-_ - .- ______Distance om oundation----- -------------Distance to nearest lot line------- ------- Number of pits_---- -_---.-.-._ Lining material_ ___'_.. --------Size: Diameter__. .�f_ .-Depth____e ,,x' _____________ Cessp l: Distance from nearest well_________________Distance fro oundation_.__________.______.Lining material___...._-_-_--_----.----_-_____._____- ❑ Size: Diameter- ------------------- - -------Depth---- -----------------------------------------Liquid Capacity----------------------------gals. N I Privy: Distance from nearest well- - ---------------------------------------------Distance from nearest buildin g-------------------------------------- El - - ------------- --❑ Distance to nearest lot line------------------------------------------------ Remodeling and/or repairing (describe}:---- -------- - --- ----------------------------------------------------------------- ------ ---- ------- ------ ---- --- --- -- - ---- -------------------- ------------------------ ----- ----------------------------------------------- ------------------ -- ---- --- -------------- -•---------- --- -- .w t� -- 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 of the San Joaquin LocalHe h District. (Signed)_ _/ .9�___� ____(er;bartaadLer Contractor) Sy:-----------------------------------------------------------------------------------------3ws, -- - -- -- --------(Title)--------- - -------------------------------- - --- ------------ (Piot plan, showing size of lot, location of system in relation tobuildings, et ., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---- ------------------------------------------------ -------------- DATE---- '- ��-- � REVIEWED BY--------------------------- --------------------------------------------------- - ---------- ------------ --------------------------- DATE----------------------------------------------------------- BUILDING PERMIT ISSUED-------------- ------------------------ � -- ------- -------- ------ DATE----:J"4 ------------------------------------------- Alterations and/or recommendations:_ '1-� -- _V_ __ OS-_ ..___ :✓ ^- __ G____ ___________________________ ---------------------- -------------------------------•----------------------------------------------- - ------------------ ------ --------------------- ------------•---------------------------- -------- -- ------------------------- -----------------------------------------------------------------------------------------------•----------------•----------------------•------------------ -------------------------•--- ----------------------------------- ------------ ---------- ------- -- -------- --------------------- ------------------------ - ------- ---------------------------------------- ------------------- `= -------------- -------------------------------------------•--- ----- - - -------- ---.-.---------------•-------------------------•-------•--•------------------------------------- - ------ FINAL INSPECTION BY:_-,; � �. ,' Date--- - --- -- 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.P.0 0.