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�R OFFICE USE: -7 /"- APPLICATION° FOR SANITATION PERMIT Permit No. .. 5.� --------------------- - - -- (Complete in Duplicate) /� Date Issued --_._-_--._.-_---__4--1/ _-1 .-_--___.---.-.- This Permit txpires 1 Year From 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 A LOCATION------------- - Owner's Name -• ---------- ` "- "' 4 �"�' �`� Phone..__ .f-_.c�_ L--- Address--------5A---7- - ------. - ----- ------- i -----..._.. Phone---- - 2 Contractor s Name---------- ---- ----- --- A ------ ------ ---- ---I---------------------------------- - � Installation will serve: Residence ®" Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: 1-_-__ Number of bedrooms ---�- Number of baths __-?�I__ Lot size _____ •_______________________ Water Supply: Public system ❑ Community system Z' Private ❑ Depth to Water Table _4�47 ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam fn Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date--------------------) No 2-- New Construction: Yes Z� No ❑ FHA/VA: Yes KNo ❑ 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__*1_1'1 _Distance from foundation----�U___-_-_.Material__9----------------------4 '"`''� No. of compartments____.fir_------------___Size.Sy.� s 'r..-` ___Liquid depth------- .--_._--Capacity_._/ Disposal Field: Distance from nearest well_N"!tt-c._Distance from foundation__..�.d-._______-.Distance to nearest lot line----g._____.__ Number of lines----------Z---------------------Length of each line- _--_7_a_-_?i--_-_.-.Width of trench---------.L------------------- f_ Type of filter material____60c--k-----Depth of filter material __./P---- -------.Total length--------- ------ Seepa4I Pit: Distance to nearest well--- __Distance from foundation___1__�..........Distance to nearest lot line---f__--____-- [L]' Number of pits.-..L___._--.__---_Lining material--- C_-�c _.Size: Diameter._.-__. ."_.--_Depth_--_.SSP--_______---_-_•� Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material----.--------------------------------� ❑ Size Diameter Depth Liquid Capacity 9als.'f Privy: Distance from ne _-_--._-.___-_-_._____-_------------------_Distance from nearest building_-.___:-_---_-_-__________-_._--_----_- ❑ Distance to nearest lot line---------------------------- ----------------------------------------------------------------------------------- ----------------�i Remodeling and/or repairing (describe):-----------------------------------------------------------------------•- •--------•- ---------------------------•-----------------•------•l. -------------------------------------- -------------------•---------------------------------------------- --------------------------------------------------------------------------------------------------------------- I hereby certify that I have prepared this application and #i�t theRwork will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations oft an Joaquin Local Health District. I , (Signed)----------- '` `----- -- ---------------------------------------------------------------------(Owner and/or Contractor) BY: t ----------------------- ----------------------------------------------------------------(Title)------ ------------------------------- ------------ (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY DATE 7 - -- ------ REVIEWEDBY----------------------------------------------- - DATE------------------------- ---------------------------------- BUILDING PERMIT ISSUED-----_------ - DATE-`------------------------ _ _ Alterations and/or recommendations: 5 �t �. '--•------F.— i ''� �f � `---��t�-�--------�z_` �� ...�- � �-------- ------------ -y---- `' - = =�e.�L ------------------- --- -- -- ?� g = "' � . 'L-�—L."� t — j 2 z cz �� 'r, ��--c ________________1 L am...-. ._11----_.�__.-_- _____ - �_`_<"�_f___(h_°/_.C__S------------------------------------ _______________---------___ ___ ________________________________________________________________________________________________________________________________________________--------------------______________ FINAL INSPECTIONBY: =AN Date------ -- ---- ---QUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca„ dlifornia Tracy,California F.P.CC.