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USE: / '_. APPLICATION FOR SANITATION PERMIT Permit No. --- ----- - v.j- (Complete in Duplicate) This Permit Ex ices 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. r.� JOB ADDRESS AND CATION. ..� � _ :---- /llilah'� Owner's Name---- l(q' - ----- -------------- --- - -- ----------- Phone--- -- --------- - ---------- Address-- ,. i = ------- � Contractor's Name... .:: - -_ 1 --_-_ ------- ---- ------- ------------ ------ - ------------- one-------------------------- - -- Installation will serve: Residence Apartment House El Commercial [] Trailer Court ❑ Motel [f Other ❑ Number of living units: -. -_- Number of bedrooms _J Number of baths --- Lot size11_�----------------- ----------- Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table �:.`lTft. 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 Q" New Construction: Yes ❑ No E FHA/VA: Yes ❑ No D- TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearesr well-----_—------Distance from foundation_._ ______ No.fo. of compartments-- ------- -----------Size_.�7� '_ .- „---Liquid depth .-- �'-----.... Capacity f�tq _-.------ Disposal Field: Distance from nearest we!! .--- -.---Distance from foundation----/Z111........Distance to nearest lot line---,l_-.---___ ©� Number or lines-------/_ ? .._.__- Length of each line_,J,e;'----------------Width of trench.. --..___.________-___- Type of filter material.-/ .i ,xr /_—Depth of filter material,.. _ __ __ �'' Total length__ Sry .____.__._-___ Seepage Pit: Distance to nearest well-----— -----Distance from foundation----f�.......Distance to nearest lot Fine.. VJ ' Number of pits------` --------Lining materia!_-�%CJ�Ci _Size: Diameter__ A Depth- Cesspool: Distance f,•om nearest well---------- ------Distance from foundation---------_------- Lining material__._. -_- ----------------- - - - ❑ Size: Diameter..---------- - -- _ - -- _- ..Depth - --------------- - ---- Liquid Capacity- --------------------------gals. Privy: Distance from nearest well----- --------- ---_- - -------------_---_-Distance from nearest buildin ❑ Distance to nearest lot line- _._._.....- -- --- - - - ------------ Remodelingand/or repairing {describe):--- -- -_ _ ,,r_ - - _ _ ------------------- _ � Z - --...._ ----- - ---___-----_ A 1 ------------------------ --------------------------- - ----- - ----- ------ -- ---------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County 1 ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed) -------------- ----- - (QMWAw—a-ii r Contractor) By: - -----(Title).--(Pl of plan, showing size of lot, location of system in rel n to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--- - --- ----------- L`" - ----- DATE.------------f - �--' � — REVIEWED BY---- - ------ ---- ---- - - - ------ - - --------- - DATE----- - - BUILDING PERMIT ISSUED-,----------- --- ------------ DATE- --------------- ------ ------�_ Alterafio and or recommendations:------------- - --- -.- - --------------------- t -- -l`�---64.1-'. ----- /?-- ---< - C --- - - - - FINAL INSPECTION BY:--- ._�= Date :"_L..`� '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.C C.