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F ROFFICE USE: 3 G 5 (5 ---------------------- j ------- OPLICATION FOR SANITATION P --------------------------------------------------------- IT Permit No. -------------- ---- ----------------------------- (Complete in Duplicate) - r'' � Date Issued --------------------------------------------- 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. �� .- JOB ADDRESS AND LOCATION 141 _`� Vii✓ ' -----"-- 601 Owner's Name----------- r e-Y--------------- --- -------------------- -""----------- Phone_! _, � y Address-------------------------------� 5-------------� .x....--..(z.3------------�-? ��',�-��_-_-------_--_----_------------------•-------•----------------. Contractor's Name-"-----"---" 1¢/i-?-_e lS. ---_;r-='_L"'"- --' ------------- ----------------------- ---------------------- Phone.. '!e_e Installation will serve: Residence Q" Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ----- Number of bedrooms _- -. Number of baths ..j-.- Lot size --------------_---_------ Water Supply: Public system ❑ Community system ❑ Private [��Depth to Water Table -,r-- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam D-Ibay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date-----------------.__) No Q' New Construction: Yes ❑ No FHA/VA: Yes ❑ No E�--- TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) 7 Septic T k: Distance from nearest well-oW--_-Distance from foundation_rO_--_-...-.__.Material_.--__"-----.-------------------------------. No. of compartments- - .lp_.. ---Liquid depth_.S'r ..:_-------Capacity__la�f'_avle-1 Disposa Field: Distance from nearest well._*'_/$istance from foundation.-AzP--........Distance to nearest lot line._�T-. Number of lines------------ ----------.__. Length of each line---C _._-, ----..Width of trench---.---off -------- --------- Type of filter material-- __ A� ..-Depth of filter material.-Z V____ --------Total length_-_fes -__-._._-_-_----- 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-.--------------------------gals. Privy: Distance from nearest well--------------------------_---------------------.Distance from nearest building------.---------------------------------.. ❑ Distance to nearest lot line------------------ ------ ------------------------------......--------------------------------------------------------------------------- Q Remodeling and/or repairing (describe): -'C! �'G�� : -------- ^/E�! 1"` �i`�� POO _: -------- �. ---------------- ---------------------------------------------- ---------------------------------------------- ----- ---- ---------------------- - - ----------------------------------------------------------------------------------------------------------------------------------------------------------------------- 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 of the San Joaquin Local Health District. (Signed) --�-�---------------------------- ( / ) O r or Contractor BY: �------ - -------- ------------- (Title) - (Plot plan, showing size of lot, location of sy m in relation to wells, buildings, etc., can be placed on reverse side). l FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY '- ----------- ------------------------------------------ ------------------- DATE----'----f-- REVIEWEDBY------ ----------------------------------------------------- -------------------------------------------------------------. DATE---- ------------------------------------------------------ BUILDINGPERMIT ISSUED-""--------------------------------------------------------------------------------------------------- DATE---------------------------------------------------_------ Alterationsand/or recommendations---- ----------------------------=---------------------------------------------------------------------------------•-...------------------------------------- --------------I----------------------------------------------------- ----------------------------------------------------------------------------------------------...-------- --------------""-------------------------------------------------------------------------------------------------------------•----- ---------------------------------------- ------------------------------------------------------------------------------------------------------------------------------ ---------------------------------- ------------------ ------ ------------------------------------ -------- •------------------- ------------- ----------- --------------------- ---------_---------- ------------ ---- ---------------- ------------------------------------------ --------------- --------- ---------------•-- ---------------------- ------------------- FINAL INSPECTION BY:.---= =`-` L _._ .L -------------------- Date------- ------- 5---- �- 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.P.CO.