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I-UK OFFICE USE: -------------------------------------------------------- ------------------ APPLICATION FOR SANITATION PERMIT Permit No. � ---- ------ -------------- 4 -- ------------------ --- (Complete in Duplicate) --- ------------------------------- This Permit Expires 1 Year From Date Issued 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...__ Owner's Name---_._ _ IVI - -------- - -- ----------. Phone-------------------- ---- ---------------------------------------- Address............. , --------------------------------------------------------- _____________________"-_-_--_____________-.-_-_ _-_ ontractor's Name ________" �e�r��D - // // ---------------- ------ Phone_ Gf Installation will serve: Residence � partment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _/__ Number of bedrooms --/--__ Number of baths '_ Lot size Water Supply: Public system ❑ Community system ❑ Private [Depth to Water Table l_S ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: (If yes,date--------------------) No P'`New Construction: Yes [9001'qo ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well-,0_0!�_tDistance from foundation__/4.- ------_Material-"�./1�---- -- P�, r t.� No. of compartments_.__.©..-____._/_rSize__�/��.�x,$'�(' -_.Liquid depth..._.� .____Capacity._l_�fid_-"- _ GL.�� ---- ------- Disposal Field: Distance from nearest well..- Distance from foundation.__.__ -- �.U.._._..Distance to nearest lot line__.. ___... Q-� Number of lines------Ca�____. Length of each line �-�t ----- g *f"'._+.�c%_.___..Width of trench__.__..p�"- Type of filter material________!____ -G�IrDepth of filter material___ - .� ---------Total length------ ----------------- Seepage it: Distance to nearest well/m,-__- --Distance flgrp fou ation._.1.�--..---.Distance to nearest lot line__ -;-_&_ Number of its __ �� " `� P ---------"---Lining material-.- _ ----- Size: Diameter----a3--------_-_Depth___„►�-.�,-------------------- Cesspool: Distance from nearest well-----------------Distance from foundation----------.---------Lining material------.------------------------- - Capacity . _ U ❑ Size: Diameter---------------- -------------------Depth-.----------------------- ------------ -----------Liquid Capacity-------- -------gals_. 1 Privy: Distance from nearest well_.-----------------------------------------------Distance from nearest building Distance to nearest lot line_________________________ -•------------------ jej Remodeling and/or repairing (describe)-------------------�aF��Z•C.Q,r....... � J" -- ----------- "----•------"----- -----"--------------------- ------------------- ------ --- -------------------------------------------------------------------"-------•-----------"----------------------------------------------"--------------------------•"-------------"-------------------- -------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, St laws, d rules and reg!ilafionylpf the San Joaquin cal Health District. (Signed)_ ----------------------------eedon Contractor) - w rand or C orJ -- --- - ------(Title)--- -- --- --------- ---- --------------f (Plot plan, showing size of lot, location of system in relation to we , buildings, etc., can be plareverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED B _ DATE_.__._�f- a` 4 REVIEWED BY ---------------- -------------------- ----------------------------------------------------------- DATE---------------------------------- BUILDING PERMIT ISSUED--------------------------------------- Alterations and/or recommendations:----------------- -----------------------•-------- FINAL INSPECTION BY �'� - �� `----------------�� -.. Date_---.��_._.=------��s�-'�-------------------------------- 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.Ca.