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T - J FOR OFFICE USE: F - - Permit No. ;V11-2111-1p.-_ ------------------ APPLICATION FOR SANITATION PERMIT ------------------- --------------- --------------------- (Complete in Duplicate) Date Issued l -"_ -- This Permit Expires 1 Year From Date Issue Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work here' scribed. This application is made -n compliance with County Ordinance No. 549. C`7U—! JOB ADDRESS AND ATIPN_ _- - -- --- -~� -` ' Owner's N -------- ------------------ - Phor��- f Address----- _ - ---- - -- - - -- -- - i Phone. = ------------- -- - ----- ------------ Contractor's Nam - - Installation will serve: Residence Apartment House Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ : . . : ljsim�,ar s_.-]_-- Number of baths - ---- Lot size _ - ' - rrlurl� ' Address D �. �?:�-r�,, City Coa � Character o1 soil to'a depth of 3 teet: " )anci LJ kz7ravei Li op,�y --r -- Previous Application Made: (If yes,date--------------------) No ❑ New Construction: Yes to ❑ FNA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public se er is available within 200 feet.) !4 � L--.M tenial_- - - --- ------- ----- Septic Tank: Distance from nearest well �.____-Distan from oundation �____..-- 5ize� - -- Liquid depth__--�ll-----------Capacity._/� ----- I No. of compartments_.----" r� �__"Distance to nearest lot line___l.> ____- Dis al Field: Distance from nearest well-7 Distance from foiindation__/1�-___ �'o Number of lines___._--"�--.- -- . "--Length of each linel0l?-�----5�- .Width of trench_ _________-..____-.-1-___ � Type of filter materia __Depth of filter material --_ Total length______________:___-_�" --------- F Seep e Pit: Distance to neares well.[ �Q�. Distance from foundation_10—e--_--.Distance to nearest lot line------ ------- Number of pits.- p----- ------Lining ma terial_Ro -Size: Diameter-Z-5-/t------Depth__.-v�o_!--------------- I Cesspool: Distance fi•om nearest well_________________Distance from foundation.......... material___.-_-________--_-.---________-_.__. Size: Diameter--------------------------------------Depth-------------------------------------------- 3-- ---Liquid Capacity--- --- gals. El �( Privy: Distance from nearest well--------------------- ------ from nearest building-----------------------------------------. `� ❑ Distance to nearest lot line------------------- T ----------------------- --------- Remodeling and/or repairing (describe):------ ---.------- ---------------- •---------------------- ------------------------------------------------------------ j ------------------------------------------------- ---------- ----- -------------------------------------------------------------------- i 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,�ail� rules and regulations of the.fan Joaquin Local Health District. YL SeE1q - , Contractor) -- ---- ------ ------------=-------- ------------- (Signed)------------ -------------- d_ ___ __ ..... __----------------- -------------- }Y - . _ _ ___ {Title) —B SEPTICTA (Plot Plan, sshowinginsieo%'lot�l of system in relation to wills, buing c., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED - ----------------------------------------------------------- DATE- l1---------------------------- BY------ REVIEWEDBY DATE------------------------------------------- ------ BUILDINGPERMIT ISSUED_"----------------------------------------------------------------------------- DATE -1 Alterations and/or recommendations- ----------------- ---------------------- •----------------------------------------------------------------------------- - 1 --=------------------ -------- ------------------------------ ---------------------------------------•---------------------- ----------------------•-------------------------- ------------------------ j ------------------- ------------------------------------- ----------------- ----------------I------------- -------------------------------------------------------- ------------------------- -------------- ---------- ---------------------------------- cd--/!te`�j - } --- ---" == Date------- -- ` . --------- ----- ---------------- -------- FINAL INSPECTION BY:..----_. ------- - . { 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.F.00. S