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rUK vrrll k USt: _ -_C, APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) This Permit Expires 1 Year From Date Issued ate Issued ,1-- ,a - 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. j JOB ADDRESS ANP LOCATION____. °_ .-_ -�.. 2� L . GLIB Owner's Name ; - ----------- ------------- Phone---?31 - / 0r-0 Address---------------------- ----------------------------------------------------------------------- Contractor's Name---6L�4 -------.--- Phone LT. Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -- / Number of bedrooms _3_.. Number of baths _`._. Lot size --- -- Q -.--____.---- ------------- Water Supply: Public system ❑ Community system ❑ Private 9 Depth to Water Table[)- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ AdobeJJZ Hardpan ❑ Previous Application Made: (If yes,date ) No X New Construction: Yes X No ❑ 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--:5 ..Distance from foundation/G`.___...____Material_._. :`.'4e_ [.l P -- -.-Size''AX 5 . - -- id de th --Y- No. of compartments--- -..__Liqui p Capacity-, _C3_l5_-� � Disposal Field: Distance from nearest welf.__57Z'___Distance from foundation_.R.P___......Distance to nearest lot line'__-____._.. Number of lines----- ------- - - --r------ -Length of each line___'. -- a -- - - -- - -_.Width of trench...- - --------- Type of filter materia!___!_ , --- --_- Depth of filter material.---/.c�'_Y------Total length-------------- ---/---------`----. Seepage Pit: Distance to nearest welt./,co----------Distant rom foundation___? -1----- Distance to nearest lot Number of pits----- Lining material4Q" ---- Size: Diameter__. _-9�.--.---- Cesspool: Distance from nearest wei!-----------------Distance from foundation---------. _.___ - Lining material---------- -- ------- ❑ Size: Diameter------------ - -- -.Qepth..._- . - --------------- ---- ------..Liquid Capacity - ---- -- gats. - Privy: Dis#ante from nearesf yell ____ -.---._Dist ____ from nearest building ._____._..._. -------- ---------- istance to nearest lot fine._._.--___ - Remodelin and/or repairing (describe):___----_- _- t • ------------------- ----------------- - ------------- ------------------------- ---------------- 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 r s and regulations of the San Joaquin Local Health District. (Signed) r - t ( e / Contractor) "�" Own r and/or ------------- BY:-------------------------------------------- _ - �� c Title t ( ) (Plot plan, showing size of lot, location of system in relation f ells, buildings, etc., can be placed o reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED - - - - --- BY- REVIEWED �---- -.. BY .-- ..__ n,---- - --------------- ------------------------- _ -_ -- ------ ----- ------------- DATE--.. ---------- - -------------- ------ BUILDING PERMIT ISSUED - ----- - DATE- ----- ----- --------------- - ---- --------- - -----------------.---- Alterations and r rec menations.._.____ ___.___ --. . ---- -- --... DATE...__...-..- -- -------- - --- ------ -- -------- ---_ - ------ ------ --------------------------------------------------------------------------------------------------------- -------- ---- - ---------------- -- - ------ -------------------- u � FINAL INSPECTION BY:----- - 165 Date. ------ - - - ------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1801 E.Hazellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton, California Lodi, California Manteca,California Tracy,California F.P.r Q.