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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. . Qd.. --------------------- ------------------- ---------- -- (Complete in Duplicate) Date Issued .................... . -- This Permit E-xpires 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 ��ty Ordinance No. 549. (a i� ----�- `------ JOB ADDRESS AND L ATION_ L`'H(x_ ........._-�. 111_ ( Owner's Name------------ P�4-----------/_ .I:__177.----- _ Phone------------------------------- Address-----------R-TF—.- ..__. ........:....Fj__PO.1[�:^_------------.....------------------------------------------------------------------------------- Contractor's Name-digAl-1-S---140 JK �-----___1d7j�---1)aUDA11191 R F:---_ ------ZK00_E�_'S71-0 _ Phone------------------------------------ Installation will serve: Residence ❑ Apartment Houses]] Commercial ❑ railer Court ❑ Motel ❑ Other ❑ Number of living units- I------- Number of bedrooms 3___ Numbler of baths 2.-_.-_ Lot size ___ -/- _C:K - ---------------- Water Supply: Public system ❑ Community system ❑ Private ��epth to Water TableZ� _ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ SandyjLtoam Clay Loam E3 Clay E] Adobe[j Hardpan Previous Application Made: (If yes,date-----------_--------) No,�New Construction: Yes ET-_'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--/- _ ___ -IW No. of compartments..---2. --------.�Size-_,!�Xffl._X_!-iquid depth__�� --------Capacity--- 6- -a ..,Distance from'hearest well___, t._Distance from foundation___ Distance to nearest lot line----------------- Number ------------- Disposal Feld:,, �+ ,, _---- �-- Number of lines--- --._..__..___. _Length of each line__�JJ�_"� _.E�__�_.__Width of trench_______- �`--- --_ i Type of filter material---] _CX f_Depth of filter material---.-/-9- -_--_Total length--- ------------------ -._.-- { See^pa�ge P' .` Distance to nearest well---- ---"_Distance from foundation_JO-----------Dist nce to nearest lot..line__- - V Ll Number!of-pits:—�_ _-=-L-ining.materiaLR_0_�-jK...Size: Diameter'_-_ -... p Z._ X�x------De to--� -_ --- -f-------------- in Cesspool: Distance from nearest well--------I----- Distance from foundation------------ ___Lining material..-_ ,-- - ---------------------- k. ❑ w. .. ,, _ * 1 a � � "Size: Diameter. _-----__ DePth -:.. _ Li uid Cacitis.______.--__ Privy: Distance from nearest well---------------------------------------------------Distance from nearest building. __--_--.._--------- %0 ❑ Distance to nearest lot line__ --__ , 1 Remodeling and/or repairing (clescri4):__--- ------------------------- - I ...,. ' - ---------- ------ i ------------------------------------- -------------------- ----- ----------------------------------------- ` t - -- - - --A- - --- ------------------I --`----------------------- I hereby certify that,).have-prepared Phiis application and that the work will be done in accordance with San Joaquin County ordinances, St s, and rules and regulations of the San Joaquin Local Health District. f ~ i. {Sign "- ------------ --------------------------- (Owner and/or Contractor) $Y:-------------------------------------------------------------------------------------- ----------------------------,�;:-=----------(Title)--------- ------------------ --••-------.........----------- (Plot plan, showing size of lot, location of system in relation to wells, 6uildings,-�etc., can be placed on reverse side). # 1 - - rFOR DEPARTMENT USE ONLY'd $ -� �..,.._.__ ...� ,,- -•-•--.rte .�.,�,�,,. � ,.� - - _ _ `. APPLICATION ACCEPTED BY------ ---------- ------------------------------------------------------------ -------- ------- ------------------ ------------------ DATE------- '-�--- :.,. _L?_ ------------- REVIEWEDBY----------- ---------------- ----------------------------------------- ---------------------------------------------------- DATE--------------------= _ iT 1 1 BUILDING PERMIT ISSUED------------------------------------------------------------------------------------------------------- DA-TE--------------------- --- ------ - ------------------ Alterations and/or recommendations:------------------------------------------ --------- -------------------------------------------------------------- ----------- --•---------- -------- ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------.--_----__-.___ c C _..__.----------------"'----------------_----__--------------------- _._----------__------------ ••-__-------------_--------_•---------------- _-------------------------------------------------- _---------------------------- A 1W FINAL INSPECTION r... f� 7 Date------------- .`..r_?..... ----------------------------------- SAN ------- -------------------------SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street l Stockton,California Lodi,CaIifornio Manteca,California Tracy,California 3