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&__VFOR OFFICE USE: 6- ------ --------------------- �j APPLICATION FOR SANITATION PERMIT Permit No. ......... ___.________-__ _. - - _ -_ _- -- (Complete in Duplicate) This Permit Expires 1 Year From Date Issued Date Issued _Y45.- 7 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�OCATION---------- --�---�-'-----�----------- ---r-�--✓�--G�-�------- ---------------------------------------------- ---------------------------------------------------------------------- Owner's Name -�/ �1�f ---------•------------------- ---- ------------------ Phone - Address -c--�--- = - ------------------------------------------------------------------------------------------------------------ Contractor's Name----{.!� 71 ��1 ----- - Phone Installation will serve: Residence [ partment House ❑ Commercial ❑ TrailE]tter 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 Tablei';'7ft. 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 2----New Construction: Yes ❑ No �A/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_________________Distance'from foundation--------------------Material---------------.------.______-_-___---______----. y T�.��/�f0 0. of compartments Size - Liquid depth Capacity isposal Field: istance from nearest well-----------------Distance from foundation------.-------------Distance to nearest lot line-________:_-_-_-_ Number of lines___________________________________Length of each line---------------_-----------__-Width of trench_---------------------_---------- 0i/ pe of filter material------------------_------Depth of filter material---__--------____ -----Total ' foundation . length___.__-__._____._-___________________ See a istance to nearest wI ' -_-__-Distance m ___•-1- ----Distance to nearest lot li ------- Number of pits- mate ria l_0�k------Size: N Diamete r__-_?J.//-----Depth- --/IdY__ :- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material__----___-_--_____-_.___,_-___ ❑ Size: Diameter---------------------------- -------Depth-!----------- ----------- ------------------------Liquid Capacity---------------------------gals. Privy: Distance from nearest well ______---------------------------------------------Distance from nearest building--'----__------------------------------ ❑ Distance to nearest lot line________ ___ ________ ___ Remodeling and/or repairing (describe)------------------ - - - -'��.-�-�s!�-------- - - ��---�L ----------••------------------------ ------------------------------------•----------------------------------------------------------------------------------------------------------------- -------------------------------------------------------- ------------------•------------------------------------•-----------•--•--------------------------------------------------•----------•----------------------------------------------------------------------- -------------- ----------MM------------M --------------------------------------------------------------------------------------------------------------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 s, nd ruf, (,reg ations of the San Joaquin Local Health District. 2� ----- --(Owner an /or Contractor) (Signed)---------- - ------- --------------BY� ---------------- --- -------(Title)----l=a - --- ------- --- ----- - (Plot plan, showing size of lot, of system in relation to we s, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----------Q `-- ------------------------------------------------------------ DATE------(p= ------------------------- REVIEWEDBY---------------------------------------------------------------------------------------- ------ DATE----------------------------------------------------------- BUILDINGPERMIT ISSUED_-- --------------------------------------- -------- DATE---------------------------- Alterations pnd/or recommendotions:---V''A_'_cr.S-__- 1_•-_-_-_._--_.IA-.;:?-___ --- ---Y�-----_`.-__s ---- sF ------ - `� `�" - s - --------------__------ --------------------------------------- --- - ------------------------- ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ----------------------- -------- ----------------------- ----- -------------------------------------------------- ---------------- --------------------- ------------ ------- --------------------------- -------- FINAL INSPECTION BY:-------Q------ —`--------------------- Date �C?.`_ '�_�P ------ ------------ ------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Ha=elton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.CO.