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F OFFICE USE: \ G- -------------- 3 - ___________________ ______ APPLICATION FOR SANITATION PERMIT Permit No. . .d.�J_.9 -- --- - ----�01c±- - `+�� ----- L _ (Complete in Duplicate) Date Issued -__2b A'? - -------------------------- 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. r 2- OSO—(27 JOB ADDRESS AND LOCATIOt 0. k(/.Leaf"-- � .-.----- Owner's Name---------- --------- Phone------------------------------------ AddressE -� = •�� = /.% ------------ Contractor's Name----------- --------------------------- ------------------------- -1--------------- Phone-----------••---•------------------ ~Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ 'Motel ❑ Other �je Number of living units: "'Number of bedrooms _"_"._ Number-of baths__ Lot size _______________________ Water Supply: Public system ❑ Community system ❑ Private M41pth to Water Table ft. Character of soil to a depth of 3 feet c Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam [Clay ❑ Adobe ❑ Hardpan ❑ I Previous Application Made: (If yes date___________________) No WrOlNew Construction: Yes U�- �o ❑ FHA/VA: Yes ❑ No g�^ 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 isTanr fr m foundation__ -11 __ Mat�� " """_ ®� No. of compartments--A---__--------._.S• e _'_Ook,9Liquid depth_ _______.Capacity_ ,____ -11 Disposal Field: Distance from nearest wel300/_ istance from foundationxZAP__ -----Distance to nearest lot line/�____ Number of lines_____ ___________ Length of each line---�010--b -- ---- -- of trench___.___ T ype of filter material E _ Depth of filter material___- Total length__ Q�: Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line______________.__ + ❑ Number of pits----------_---- - ---Lining material-----------------------Size: Diameter----------------------Depth--.------------------------------ ;�* r 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------------------------------------------ F1 .___.____.__________.____-- __...____._.❑ Distance to nearest lot line____________------------- Remodeling ____ _remodeling and/or repairing (describe): 4 _,Ppm----- � e�""� ' •------•--------------- F - ±. - r - - - ---- -----------------------------------------------------•---- --------------- -- I hereby certify that I.have prepared this application and that the work will be done in accordance with San Joaquin County 1 - -.-ordinances,-State laws, .and rules and-regulations of the San Joaquin Local Health District. (Signed)------------------ -�or Contractor) JJ Ei By:------------------------------------------------ ------------------ -- ---------------------w------(Title)--- --------------------------------- (Plot plan, showing size of lot, location of syste relation to wells, buildings, etc., can be placed on reverse side). � .. " FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--- --- -- .__-- --------------- --------- - .- _ DATE 7 ------------- -------------------- REVIEWED BY-------------------------------- ------------ ------ DATE_- •----------------------- \ BUILDING PERMIT ISSUED------------------------------------------- ---•- -----------.-------- f DATE Alterations and/or recommendations: 77_7 --------- T`�1 ' --------------------------- �, , ------------------------ -------------------------------------------------•"--------------- -----------• —-- - _ .. z _ ------------ ----•-"----=--..." ---- - - - -------------- -------------------------------------------------------------------------------- 7=�C (off FINAL INSPECTION $Y:_. Date- - - - f SAN JOAQUIN LOCAL HEALTH DISTRICT ) 1601 E.Na:elton Ave. t 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California F.F,r 0.