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FOR OFFICE SE: V. ---�--- ' ,------ -- ---- - -----3� ------------------ APPLICATION FOR SANITATION PERMIT Permit No. ...1-�.G 7. - - -- ----•---- `�-F------------------------- (Complete in Duplicate) y� 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........�-_-----/-_.-�.---�, G�.1��2�'�-------------------------------•--------......_....----------...---....------------ Owner's Name...........1.2 J-�.-•------4-?a 1a•.,A:-------��.�.,t --------------------------------------------------------------- Phone.................................... Address..................................... "''? e. Contractor's Name �� Q_o-�P_1°li------- �_ "-----�'� .................................. Phone... .f. `fit' Installation will serve: Residence (Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: --- ___ - umber of bedrooms __ -_ Number of baths J----- Lot size ------------------------------------------------------------ Water Supply: Public system [+Community system ❑ Private ❑ Depth to Water Table _,Y�7 ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam E] Clay ❑ Adobe 0---Hardpan ❑ Previous Application Made: (If yes,date------------ No [ New Construction: Yes ❑ No 5' FHA/VA: Yes ❑ No [ — TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Se�pti,t T,�k. Distance from nearest well-----------------Distance from foundation....................Material------------------------------------------------- 4j No. of compartments--------------------------Size................................Liquid depth--------------------------Capacity......-............... Disposal Fi Distance from nearest well ______"------Distance from foundation.__„ .,P..........Distance to nearest lot line..4=_..>_..... �- _-_-Length of each line_____ Number of lines-------------f-------_--___-_- 3-la....----.........Width of trench.._.Q.Y-11-,........_............ �'j Type of filter material___YQA__y______-_Depth of filter material.-__A--------------Total length.......X34'!........................... Seepage P' Distance to nearest well-----: _ _......Distance from foundation.../4:_`-.-_-.-.Distance to nearest lot line---SS:_._..._.. N Number of pits.___.___/__________---Lining material_t_e_!�_•c•_______-Size: Diameter----3.--32--------Depth__�2 — W Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material-------------_........................ X` ❑ Size: Diameter,-------------------------------------Depth--------------------------....----------------------Liquid Capacity-----......................gals. r Privy: Distance from nearest well---------------------..---------------------------Distance from nearest building-----------------------------_---_--_____. �1 ❑ Distance to nearest lot line----------------------------------------------------------------------- ..........................------------------.....__..------- ------ . Remodeling and/or repairing (describe):--------------------- . t ?c c'sY�cf .__.-_.. ------•----------------------•--•------•-•-----•-------------•---------------------•-------------_...----•----•---•-•-------------------•-------------•--------------...--•----•-•--•---...---•---•-----•---- •--------• ----------------------- .........................................................................................--•-•---•--•--------------•-•-••-•--------•---•-------------••------•--------•-----------...-------------- 1 hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin Coun y ordinances, State lawns, and f rules and regulations of the San Joaquin Local Health District. YJ�Z11_-•---- -- r. t�t�� 1 (Signed)----------------------- - � C --------------------------------------(Owner and/or Contractor) By:.....................................�' . �- ---------(r+le)---l.�l��- :z� l--------------------—-- --------- (Plot plan, showing size of to , ocation of system in relation to we'ils, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---6..___G --------------------------------- DATE... -----------•--------------- REVIEWED BY------------------------------------------------------------------------------------------------------------------------------ DATE------------ •--------- ••------------•----------------------- BUILDINGPERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE...................................... ...................... Alterations and/or recommendations------------------ ---------------------------------------------------------------------------------•------------------•-------•---••-•----•-•--•----------•--. ._ ^•l l j'- 7 �� . i sem" � r- -- - - ---------- •-----------•---� ----------------------------- -------------------------•-----------------------------------------`------------------------------------------------------- ------------------------•-----------------------------------------•-- ------------------------------------- -------------------------------------------------------------------------------------------------------•---------------------------•-------------.-_--------------------.......... FINAL INSPECTION BY:._-__---._- __ _ Date------ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California Ee•9 REVIeED 0-69 r.F.CD.2M 6.60