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hOROFFICE USE: ----- ----------- -------------------- _ -------------- ________ __ ___ __ APPLICATION FOR SANITATION PAGANNEOrmit No. --------- --- ' '�-�- ------ (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 LOCATIO ..-��` .---- ----- --- -- � _G.rf_____________ _ _ ------------------------------------------------------- Owner's Name -------------------- - -- %. - Phone Address----------------------------- ------------------------------------------------------------------------------------ �� ✓1�f %. Contractor's Name--------- 5.�1 / �1` _. �V �Y.�-•-----.-. Phone----------------------------------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ---I--- Number of bedrooms ---/--. Number of baths ---/___ Lot'size ----- -4-k/4Q------------------------- Water - _-----___--_Water Supply: Public_sysfem ® Community system ❑ Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑' Clay Loa rn�g Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date-------------------..1 No Q�_ NewrConstruction: Yes ❑ No IR FHA/VA: Yes ❑ No EX 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__ ------Distance from foundation--------------- Material------------------------------------------------ ❑ No. of compartments--------------------------Size------- ---------------Liquid depth--------------- ---- ----Capacity----------------------- Disposal Field: Distance from nearest well______'_: ------Distance frohi foundation:-----'--------------Distance to nearest lot line----------------- ❑ Number of lines-----------------------------------Length of each line------------------------- Width of trench----------------------------------- t^ r Type of filter�material_________________-.....-Depth of filter material-----------------------Total length ' -- --------------------- (� Seepage Pit: Distance to nearest well--------------------_Distance fr foundation---4�9.........Distance to nearest lot Number of pits._-__.l-------------Lining material l Size: Diameter._.._ - -_-Depth___.__fvZ - c Cesspool: Distance fr-0 nearest well-----------------Distance from foundation._..-.----__.---___Lining material---._.----------__-.----------------. F1 Size: Diameter--------------------------------------Depth------- - -----------------------------------------Liquid Capacity----------------------------gals, 11. Privy: Distance,from nearest well..:------------------------------------------- Distance from nearest building__. . .- - - --------------------------------- ❑ Distance to nearest lot line---- --- ---------------------------------------------------------- -------------------------- -------------------------------------- t - S r Remodeling and/or repairing.(describe)"`'" -!___-__ ---------- •''/- _ 'f/( -��'__ ---------------------------------------------------------------------------------•---------------------------•--•----------------------------------------------------------------------------------------------------------- i I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County iordinances, State laws, and rules and regulations of the Sa}x Jo i Local Health District. f (Si ned -i �J� �-.5 - - i g )--------------- �� Q✓i/S' ner d/or Contractor) B .. al R 1 (Title)----- -------- -------- --- ------------ -- (Plot plan, showing size, �Io�+, ocation of stem in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY y i APPLICATION ACCEPTED BY--- _-------- ------------- DATE-..-__---_ REVIEWEDBY :-------------------------------------------------------,------ -------------------------------;--------------• DATE BUILDING PERMIT 1551JED �7� ry DATE----------------- --------- ------------------------------ -- Alterations and/or recomrnendations: - ` 1 /Q j� `=/ / � :---------------------------•-------•---•-------- -------------------------------------------------------------------- ----- --------------------------------•---------- -----------•-------------------------- --------:---T - s----------------�--- FINAL INSPECTION BY:............. Com- Date---------------.......... `- -^ ----------- 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 ppy F.RCO. Y