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/oR'OFFICE USE: - - -------- -- - -- ------------ -- ---- - .A APPLICATION FOR SANITATION PERMIT Permit No. •.- %- ,. (Complete in Duplicate) �3 /S- -------------------------------------- -------- Date Issued _...__.. _J_..___-_-•-- ------------------------------------ ...... ___._-. 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 LOCATION---------------3- --------'�-'�-�� © h�� - ---••---••---------------------------------- Owner's Name 1._ � �� rr --- --------------------------------------- Phone__ �. 1_ IC=J Address ..�� _. `------------------------------------------------------------------------------ p 4/ �-7 Contractor's Name------------'--------------- ----- f - '7`__ --------— Phone_.__��___�__��_9�_Q_ / Installation will serve: Residence [&_�partment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -------- Number of bedrooms ........ Number of baths Lot size _______-7J _X_--1.J., ------------------- Water Supply: Public system Community system 7 Private ❑ Depth to Water Table -!Qft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made..: (If yes,date---------- --------A No Ejj_--IQew Construction: Yes ❑ No [?-F599 VA: Yes ❑ No 54— TYPE OF INSTALLATIONi AND SPECIFICATIONS: (No septic tank or cesspool permitted if.public sewer is available within 200 feet.) I, 1 Septic Tank: Distance from nearest well--------------- Distance from foundation--------------------Material------__---_--__-_--_____.-.______-.______.____- ❑ No. of: compartments-------------------------?Size--------------------------------Liquid depth--------------------------Capacity----------------------- Disposal Field: Distance from nearest well--------.-----;Distance from foundation------------_-------Distance to nearest lot line---------___-__-__ ❑ Number oflines----------------------------------r Length of each line---------------------------.-.Width of french---------.----.----.------.--------- (k Type of filter material-------------------------Depth of filter material-----------------------Total length-----------___-___._______--_---_-_---__-- Seepage Pit: Dis#ante to nearest well------`--'-._____-_Distance frgm foundation__ [ ........D' ce to nearest lot line-- l} Number of pits----/----------------Lining material_S/ood e... Size: Diameter-_ ��_-_Depth----- '!-------------- V Cesspool: Distance from nearest well-----------------Distance from foundation....................Lining material__._._________.__-___-.___-_______ El Size: Diameter----------------------- --- ----------De th----------------- ----------_Liquid Capacitygals. Priv Distance from nearest we1 ----------------------------------------------Distance from nearest building ❑ Distance to nearest lot line----------------------------------------------------------------------- ----------- Remodeling and/or repairing (describe)--------- "----- -- ---------777U-------6' ,4:f l.g ,!It-- --'-L----E�_�_-__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, an egulations of the San Joaquin Local Health District. !. (Signed --- 19 lex;?_ �, ~r 9 - 1 .�1�- _ er d/oh Contractor) By:------------------- :. ------ --- ----- ---- -----------------------------------------(Title)------ ----------- --- ------------ (Plot plan, showing size of lot, location of Sys t m in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---------- _. `------- -- -- DATE---- =-��` ti+- ---------------------------- - ------------------------------------------------------------------ - - REVIEWED BY------- ----------------- - -------- --- ---------------- ---------- -------------- ------------ -------------------------- DATE-----f-------------------------------------------------- BUILDING PERMIT ISSUEb------------------------------------------------------------------------------------------------------ DATE---------------------------------------------- ----------- -- I; Alterat�o hand or reco rn da ions .; a2 7` ` -- ------ -1 - ---------------------------------------------------------------------------------------------------------------------------------- �� -------------------------------- ---------- ------------------------------------------------------------------------------------------ -•-----------•----- ----------------------------------------------------------------- -----•------------------------------ --------= - ----------- ............ --------------------------------------------------------------------------------------------------------------------------- FINAL INSPECTION 13Y,:..---.-. �--' i------ -- -------- ------------- ------ Date.- --- -�.F�:-�`�__-,� ,� --- ---------------------------- SAN ------ --- -- SAN JOAQUIN LOCAL. HEALTH DISTRICT 1601 E.Hazelton Ave: 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California I Lodi,California Manteca,California Tracy,California I' F.RCO.