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FOR OFFICE USE: .F ~1�� APPLICATION FOR SANITATION PERMIT Permit No. '- � - � ------- (Complete-in Duplicate) Date Issued ---# This Permit Expires 1 Year from Date Issued Application is hereby made to the San Joaquin Local Healfh District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. �S/ �- Dr --- - - ----F--- -- -------------------•----- ------- JOB ADDRESS AND LOCATION_______ _ - ------ L!E' ------------------------------- - Phone------------------------------------ ��---A!� - -- Owner s Name__________ t � g f------------------------•--------------------------------------- Address----••---Z6- j.-. Contractor's Name-- ._.-�It.1 -- - -ti --- � --- ��--------- Phone7"`!o-� }men{ House C' ornmercial Trailer Court ❑ Motel ❑ Other ❑ Installation will serve: Residence Apar ❑ e X _��a_x--- ara i Number of living units: _.f __. ___ Number of bedrooms r_ Number of baths.-/---- --- Lot size f�7_oX --- Water Supply: Public system,%P�Community system ❑ Private ❑ Depth to Wafer Table ft ❑ y Adobe Hardpan Character of sofa to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam Clay ❑ ❑ Previous Application Made: (if yes,date------------------- ) No ❑ New Construction: Yes ❑ N FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: ` (No septic tank or cesspool permitted if public sewer is available within 200 feet.] r ---f--- Material ----------- - -- --- ------ - Septic„Tank: Distance from nearest well- _ jllj-el Dista c from fou �ipn___ Ca acit 6 No. of compartments_ Size . - Liquid depth__--.- - p Y --- - --- ------ / !-i9"-_._..Distance to nearest lot line__ _____ Dispos I Field: Distance from nearest weli1i�kl .-_Distance from foundation___ _ l �? ___Length of each line__ _ ---!.............Width of trench_S ---- Number - ------------ �[ Number of lines _---�--- -- -� ----- - 9 � -- Type of filter materi j P .-_.Depth of filter material--f-�n-----Notal length________________ �------ f 47.-----Distance to nearest lot Se a e Pit: Distance to nearest wel -o_v. ------Distance from foundation_ �+p Size: Diameter__.-e ._-__Depth_-.-s7�d ---.- Number of pits-1- --------- -----.--Lining material._. _ �- -. --------------------- Cesspool: Distance from nearest well ____._.__- __Distance from oundation----------------- -- mg material-------------------------------------- cesspool. -.______gals. ❑ Size: Diameter- -- -------------- ----------------Depth-------------- ------ -- -- LiquidCapacity Privy: Distance from nearest wail_______.......... .... .-------------.--Distance from nearest building-_-------------------------------- .._-_. < ❑ -------------- ------------------- ------------------------------ Distance to nearest lot ine ----------------------------------- ------------------------------------- Remodeling and/or repairing (describe):--.-___ .. _--- - ---------- ----------- ------- ------- ..- •� � 'fin`-' ' - ---------------------- ------------ ---------------- ------------------- ----------- ----------- ,--- --------- --------------------------------------------------------- -- --- ---- -----------------•-----•-------------------------------------------- ------------- -------------------------------- --------------- l 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 a San Joaq n Local Health District. (Signed)--7LZ `° �' 1------- ------ ------------------- r e"" IIr Contractor) % --- ----------- -------------- --------------------- ----------------- (Title)l (Plot plan, showing size of lot, location of system in-fel n to wells, bu' ings,_etc., can be placed on-reverse side). FOR DEPARTMENT USE ONLY'._' V '---- DATE'.#-y- � ------- APPLICATION ACCEPTED :; -------- ----- ` ` I ATE-------------------- --------------- =----------------- REVIEWEDBY------------------------ ---------- -------- ----------- ----- -------- ---------- ------ -------- DATE'-------- --------------' ------------------------- BUILDING PERMIT ISSUED-------- __.___-._ ---- -- ---------------- -------------- ----------- Alterations and/or recommendations:...._. ....... 3�3 ------r-- ----------------------- ` - - ----- ---=--------------- --------L------ - --------- ------------------- - - --._.... . ------------- ------ --- ----------- . .. --- ---------- --- ------ ----------------- { FINAL INSPECTION BY:.._-- ___--- Date / -K.-------------------------- SAN --- - --- -- ------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1401 E.Hotelton Ave. 300 West Oak Street 124 Sycamore Street :. 205 West 9th Street Stockton,California Lodi. California Manteca,California Tracy,California E.H.9 2M 1.67 Vanguard Press i