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FOR OFFICE USE: . 0 t� Permit No. l _ 7 --- -------------- ----------- --------•--- ------------- APPLICATION FOR SANITATION PERMIT --------------------------------------------------------- (Complete in Duplicate) Date Issued s�:`'9-_- _---_-______---- 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 herein described. This application is made in compliance withlCounty Ordinance No. S49.. JOB ADDRESS AND LOCATION__. a (/'e- C�.="` ��t� f �' F-'-- G` -�- ---- Owner's Name.__`��=----- �,.Y�=_ _�.S_s:2 �------------------------------------------------ ----------------- --------------- ------ Phone .3--- Address----�-'�=-��---•- ---------------- --!.�P--------- -------••-------•-------...----------------•-------- -- ---------------� ----------------------------------------------e-jjrp--- Contractor's Name $' r*�_ vI!_�J_ •s- ._ '�"`� ,l-. 7 _-�;Ai-Phone_.�lF �_^------------------- Installation will serve: Residence ❑ Apartment House ❑ Commercial ©- Trailer Court ❑ Motel ❑ Other ❑�� Number of living units- -------- Number of bedrooms -------- Number of baths _______ Lot size ------f� .r75------------------------------------ Community Private ©' Depth to Water Table -_ - ft. Water Supply: Public system Elit system stem y ❑ . Character of soil to a depth of 3 feet: Sand ©' Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ HardjNo Previous Application Made: (If yes,date-___-_>-------------) No 2- New Construction: Yes ❑ No P- FHA/VA: Yes ❑TYPE OF INSTALLATI ON AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.)Septic Tank: Distance from nearest well__Sc_�___--__Distance from foundation_-_l!'_-_--___ _.Mater`al_ a?--- ----'�`�=------No. of compartments --------------------- Liquid depth s CapautY �S ° Disposal Field: Distance from nearest well._,re--------Distance from foundation__/�_.___.__.Distance to nearest lot line_J� Number of lines----------�X----------------------Length of each line------1----------------.Width of trench----Z-`-----------........ .---- Type of filter material---- 4 i!_-A_-__-_-Depth of filter material__._--_6y-.._____.Total length___-_--Z_ 'V_y_______________----- Seepage Pit: Distance to nearest well------.---------------Distance from foundation-------_------------Distance to nearest lot line___--_-_-_______ ❑ Number of pits----------------------Lining material-----------------------Size: Diameter-----------------------Depth...-__-------------------------- Cesspool: Distance from nearest well-----------------Distance from foundation----------------____Lining material------------________________--_------ ❑ Size: Diameter-------- ------------ Depth-------------------------------------------------- -Liquid Capacity------------------- ----9als, Privy: Distance from nearest well-------------------------------------------------Distance from nearest building___________--_____________.____..... ._. ❑ Distance to nearest lot line- ------------------- - ----------------------------------------------------- ------------------- ------------------- Remodelin and/or repairing ____ �� - f _ -- - ef^ -- -`��f r F'r it ------- {��--��"-`�_--a"4- f1Ne -----f r't`----------d` --------- _ ' ------------------------------------------------------------------------------------------ ---------------------------------------------------------------------------------------------------------------------------- ----- ---- -------------- ----- -- ----- - --------------- --------------------•--------------------------------------------------------------------------------------- ---------- 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 andel regulations of the San Joaquin Local Health District. Si nerd 0,W-4 " -- _ r"• ,4 B im' -------------------------(Owner and/or Cantractor�( g } 2 J---------------------------------------------- ------------------------------------- -I-----(Title)----------------- - --------------------- ---- -------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). O,hPARTMENT USE ONLY i --------------- DATE-----eg ��-��----�--------------------------- APPLICATION ACCEPTED BY-- - -- - ------ --- --------- ---------------- - �- ---- --- - - - REVIEWED BY - DATE------------- --------------------------------------------- ------- --- - -- - ------ - ---- BUILDING PERMIT ISSUED ---------------------------------------------- DATE---------------------- ---------------------- --------------- r Alterations and/or recommendations:----------------- ----- ---------------------------------------------------------------------------- ----------- -------------- --------------------------------------------- ----------- --------------- --------------------------------- -------------------------------------------- - -------------------------------------- FINAL INSPECTION BY------------ - � �� Date - ------------ - -- -- SA Jp IN LOCAL HEALTH DISTRICT 1641 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9Th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.co. ��