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FOR OFFICE USE: 3Q 4- � - -- - - gip - � � (�q APPLICATION FOR SANITATION PERMIT Permit No. _/!, -_!__/_Z- ------ ---------- - ---------- ----------- (Complete in Duplicate) 9 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 construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATIO uJ-- -- '-ems?-- ( ___- �! _--- - -- ------------------------------- ----- ---------- -- - - --- Owner's Name_ f� � =1� l �-7�--'�S--/-7.=-1------------- Phone.-/F4`l� r Address----------------------- ----------103,_ k.....X_ .... .... . ......... .................... ------ ------ Contractor's ddress--------------------- Confiractors Name_ `f't�l --�------------------------------- -•-- -- Phone sir ------- - 7. Installation will serve: Residence ED,--Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __�___ Number of bedrooms __y Number of baths --- Lot size ___-, �r ��' _________________ �r Water Supply: Public system ❑ Community system ❑ Private E4—Depth to Water Table f2-It, Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ]—Clay Loam B--'Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date....................) No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ 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-----------------Distance from foundation--------------------Material---..___------..--_--.._ -___----_______-----___-. ❑ No. of compartmentsLiquid de th--------------------------Capacity ----- - - - ---Disposal Field: Distance from nearest welt---_--2�6_._Distance from foundatio ---_a_�_,__.Distance to nearest lot ❑cl Number of lines------------ Length of each line__ -_ O-`---Width of trench-------—Z ��---.._ Type of filter material_____ _,��Q _Depth of filter material___f_ ---------- Seepage _r�______Total length___.-__-,p-_ _-_-__-----_-_----_ h See a e Pit: Distance to nearest well Distance fro foundation--_ p 6dt.________ _____._ Distance to nearest lot line____.-_._-.._. ® Number of pits------- ------------Lining material__- 4P/ __Size: Diameter.__ _ _` Depth----- -- ------------_-.- r Cesspool: Distance from nearest well-------_---------Distance from foundation....................Lining material-_._.--------------------_----_-_--_ ❑ Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity--------------------------.-gals. Privy: Disfance from nearest well-------------------------------------------------Distance from nearest building------------------------------------------ ElDistance to nearest lot line---------------------------------------- --------------------------------------------------------------- ---------------- --- --- ---- Remodeling and/or repairing (describe):_...----- G'---------Z ------�r- 1-/ _.a------- f_ ------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ r -----------------------------------------------------------•-•------------------------------------------------------•---------------------------•------------------------------------------------------------------------ --------------------------------------------------------------------------------------------------------------•------------------------------•-------------------------------------------------------------------------------- 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 ao gulations of the San Joaquin Local Health District. _ (Signed)------------------------------------------1�11� t� .� - _�_-____- '----------------------------- (O er and/or Contractor) BY: ---------------------- _---- -- -- r (Title) •-------------------- (Plot plan, showing size of lot, cation of system i relation to wells, buildings, etc., can be placed on reverse side). :. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-----------------010 ------------------------------------------------------------ DATE---------- ----------- ----------------- REVIEWEDBY------------------------------------------------------- ------------------ --------------------------------------- DATE--------------------------- BUILDING PERMIT ISSUED DATE Alterations and/or recommendations:. �f f� � --------------------------------------------------- ------------------------------------ ---- -------------------------•- ---- - --- ------------------------ ------------------------------------------------------------------------------------------------------------------------------------------- -------- ------------------------------------------------- --•-----------------------------------------------------------------------------------------------------------------------•----------------------------------------------- ----- ------ - -- ----------------------------------------------------------------------------------------•--------------------------------------------------------------------------------------------- -------------------- yy FINAL INSPECTION BY: _.`... . Date ' --J�S. --------- 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.C C. � f41?7