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FOR OFFICE USE: ----------- ______ �- 1 7 414 APPLICATION _FOR SA�NITATION PERMIT Permit No. ....1..._/3..... -- -- (Complete in 1�Ju Itca#e f t -�1 ( P P ) Date Issued __--_--------------- This Permit Expires 1 Year FroA Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the pork herein des ribed. This applicatio is mad in compliance with County Ordinance No. 549. x/de JOB ADI EU AN �ATIOS C-�--Iti71°JC 1'C.� l_ __.._K ..__ � -fo• el @�'rOrj--- �q....... ,�''' n ------------------------ ------ Owner's N,aame�-_-_-/�! ,__-. _-- ,P--- .---�/�/1111__!1 � -------- Phone _ �/�7- --- Address fr�_. lAe� - -�'-h- �-C.. //�� \ Contractor's Name.p �K.,t�- s r ----------------------------- --•----------------•----- Phone_ - ".2407'_/-. Installation will serve: Residence lT-<p'artment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: .__r/__ Number of bedrooms;�� ber of baths_ Lot size ./--- �-�..� ______________________~ Water Supply: Public system E] Community system Private ❑ Depth to Water Table .(O-at. 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 ❑ New Construction: Yes No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS- (No septic tank or cesspool permitted if publi sewer is available within 200 feet.) Septic T Distance from nearest welt - --- --Distance fro found �ti�,n V ..._.Material �� No. of compartments.._______________ ___Size_ ~X_.S-Ail—Ci'quid depth °�..___-____Capacity.f_Z... Disposal d: Distance from nearest wellZ___Distance from found 'o Distance to nearest lot line.,l _.__ Number of lines_______ __ ________ Length of each Width of trench__ �- ------------------ Type of filter material____ _ t Depth of filter material--_l �!__._`_Total length_______l.��r?__�_,� ,ii � � / Seepage Distance to nearesnnt w� ell-_________Distance f,�om foundation to nearest lot line___.44 .-.__.__... C Number of pits---N-._-____---_Lining material__ __ ,ec-//�-__-_-Size: Diameter---_Z�_ -5.- Cesspool: Distance from nearest well______-______Distance from foundation--------------------Lining material___.___-_______________.__._---_.- ❑ Size: Diameter----- --------------- ------- -------Depth----------------------------------------=----------Liquid Capacity_--------------------------gals. i Privy: Distance from nearest well------------------------------------------------- from nearest building----------------------------------------.. ❑ Distance to nearest lot line------------------------------------------ ------------------- ------- =•---------•----------------•-------- --------------•--------------- Remodeling and/or repairing (describe :-------------------------- ----------------------------------------------•----------------------------------------------------------.................. SY -----------------------•---------------------------- ----------------------------- ---- ----------------------- -- - - --- ----- - - -------------------------------------------•------------------------------------------------------------•---------•------------------------------------------------•------------•-------------------------------- -- I hereby certify that I have prepared this application and that the work will b done in accordance with San Joaquin County ordinances e la s, and rules and regulations of the San Joaquin ocal Healt District. l (Signed) -------------- ------- � ------- ID ,--- -- - --------------------------------------------( /or Contractor) ------------------------------------------------------------------ -------------- BY: . 1 -- ------- (Title) - - - - (Plot plan, showing size of lot, location of system in relat' to wells, buil ngs, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY / APPLICATION ACCEPTED BY____A -----------_ __ _--�' - DATE _:-_l"_'l �-------------- __ 1_ • REVIEWEDBY--------------------------------------- ---------------- -----------------------------------------------•----------._-- DATE---------- -------------------------------------------- BUILDING PERMIT ISSUED------- ------------------ - ------------- --- ---------------------------------------------- DATE------ ------------------------------------------•-.......... Alterations and/or recommendations:---Ip- ------(''r__�_Y�_4 _ k►_---------` 4-ii- - s_-------�� -A.....----- 'ag-4 . ..________--_____________________`_____-____....-__-____-___--__-__-___-__:__-__.______.a_..,__ .&----------- ------------------------------------------------------•---------------------------------------------------------------•---•-----•---•----------`---•--•-------------------------- ---------------------------------------- ------------I--------------------I----- --------------------------------•--••--•-------------------------------------- ----------•-------•---------------------------------------------------------•--------------------.------------------------------------•-•------------- -------------------------- ------------- -------------- ------------- ----------------------------•------------- -----------------•------•---•--------------------•-------•------------------------------------------------------------ C4 FINAL INSPECTION BY:----- - `' --=------- Date---------- ------------------------- ----_----------------------- A ---------------------------- AN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haselton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.CO.