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FOR OFFICE USE: �-------------------- - -- -___-__.--------------- 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 Health District for a permit to construct and install the work herein described. This application is made isc pliance with County Ordinance No. 549. S Dit= JOB ADDRESS AND�L^• ATION / L � �N Q............. --------- �o---- ©F--------- N1.Q ML Owner's Name............ STAN-�-Ef-•----•....C- 'r_RL$_N-----------------------• ---•-•---------•------•-----•----- Phone.............----•-•--•--•-------•- Address...............- --------Z---/-----D .X. I 4� T€ Contractor's Name..........ek /9E.R........................................--------------------------------------------------------------------- Phone................................... Installation will serve: Residence M---Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __ ----- Number of bedrooms __- Number of baths _Zrr Lot size _.f. QQD 17 —4— ".*--- ------------------ ----------------- Water Supply: Public system ❑ Community system ❑ Private [Depth to Water Table/ ft. Character of soil to a depth of 3 feet: Sand 2'-Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date__.------------------) No New Construction: Yes Ej—No ❑ FHA/VA: Yesjn-_No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: " (No septic tank or cesspool permitted if public sewer is available"within 200 feet.) Septic T k: Distance from nearest well__J�-_0_-__Dista e from foundation_�_d..._......_.Mate ial---4OI�CAET`�.......... No. of compartments__-__. ...— _---.--Size.Y / ..._x__�,__.Liquid depth.sS �----..__.._._Capacity...,�5�r . ._` Disposal Field: Distance from nearest well-.--. __ .__Distance from foundation.... Q_-____-_-.Distance to nearest lot line i_ V" Number of lines...... 2.---- ---------------Length of each line__-_--2-S___4-1310.Width of french-------- ---------------- Type of filter material_�Q-C- <---_-Depth of filter material-__147_____________Total length-....... �._......__..__.. Seepage Pit: Distance to nearest well----------------------Distance from foundation....................Distance to nearest lot line----------------- El Number of pits----------------------Lining material_____---.--_-.-_.--...Size: Diameter------------------ ----Depth--------------------------------- Cesspool: __________________ ____________Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material.-.._-------__-__.__-.-_---._-__--_--. ❑ Size: Diameter--------------------------- ----------Depth------------------------------•-------------------Liquid Capacity----------------------------galls. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building-----------------------------------------%W ❑ Distance to nearest lot line------------------------------------------------------------------ -------------------------------------------------------------------- Remodeling and/or repairing (describe):--------------------_. 1 --------------------•---------------------------------------------------------------------.--------------------------------------------------------------------------------------------------------------------------------- -h ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ ---------------------- -----------------------------------------------------------------------------------------------------------------._--_---------------- I hereby rti that 1 have prepared this plication and that the work will be done in accordance with San Joaquin County ..�� ordinances, to ws, end r sand regu) i s of the San Joaquin Local Health District. I� b (Signed)---- -------- ----------------------------------------------------------------------------(Owner and/or Contractor) 3 By:------- -_--=------------- -------- ------- ------ ---------`Tf_R.-?.---------------------(Title)--------- --------- - - --- -- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY /_�L APPLICATION ACCEPTED BY------rt.f3 - ------------------------------------------------- ------------------- DATE........Z -z47-.i ------------------------ REVIEWEDBY--------------------------------------------------------------------------------------------------------------------------- DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED-------------------------------------------------------------•--------------------------------------- DATE--- ------------------------------------------------ Alterationsand/or recommendations:-----------------------------------_-----------•------------------------------------------------------------------------------------------------------------ ----------------------------------------------.............................. ------------------------------------------------------------------------------............................................................... ----------------------- ------------ -------- ---------------------------------------- -----------------------------------•----------------------------------------------------- FINAL INSPECT .. Date.---- -- 7._--z 4 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.CC.