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F9R OFFICE USE: ,fir APPLICATION-fOR SANITATION PERMIT Permit No. ._.l.. S ��1 ---------- f-�r. r +___--. (Complete in Duplicate) Rate Isst3ed - This Permit Expires 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. l� JOB ADDRESS AND LOCATION/------�� I---- f----('�-- QJ ....' Z� 10 Z. r -------------------------------------------------------------------- Owner's Name----- -------- ------------•---------------•------------------- Phone Address-------_-----------_-------' -------`----'�� -- ---------------- ------------------------------------ ;-- ��^^ Contractor's Name_T `3:1_ 3 - --�6-=-------------------- Phone-. _`��----- --------------- ----------------- --------------............... - _ f _- Installation will serve: Residence Q�Apartment House Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: .___-- Number of bedrooms ---'r__-_ Number of baths ---I--- Lot size -----14�3 —A_Z --_----------------- Water __-_-_-----------Water Supply: Public system Qv_*�`Community system ❑ Private ❑ Depth to Water Table ,eft.t- , Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe M---Hardpan ❑ Previous Application Made: (If yes,date--------------------) No New Construction: Yes No ❑ FHA;(VA: Yes ❑ No Lam" TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) . Septic nk: Distance from nearest well--- ---------Distance from fou ndation-----W__1*___-.Matell---L/7 11 ------------------ No. of compartments-----__�_--_---_-Size_4-1_(_5-?t_/.Q. __---Liquid depth-------- --------------Capacity...__ 9M_-_- Disposal ield: Distance from nearest well.---_-------.__Distance from foundation...1.�_�........Distance to nearest lot line...�'____. Number of lines------------ .___--_----_-_Length of each l ine/47!! '.-� -_Width of trench---------4,--__----.--_-____-_ Type of filter materiaq:_ - p e-- g t1 _ ac _Depth of filter material__.... .__ Total length pag Pit: Distance to nearest well-.-_-------------Distance from foundation_..../_4-._...Distance to nearest lot line--l-E, ------ See Number of pits-----... --�--_-.Lining material__A& ---_..Size: Diameter--,-.? --- --__Depth.._- -_'_________________ Cesspool: Distance from nearest well-----------------Distance from foundation------------------- material__._-.-_-____________________________ ❑ Size- Diameter-------------------------------------Depth------- --- ----- ----- ------- --------Liquid Capacity---- - -------------------gals. fi Privy: Distance from nearest well_.----------------------------------------------Distance from nearest building--------------._---__-___.__----------_-. ❑ Distance to nearest lot line---------------------------------------------------------------------- ----------------------------------------------------- ----------- Remodelingand/or repairing (describe):------- --------------- ------------------------------------------------------------------------------------------- ------------------------------------ �f ---------------------- --------------------------------------------------------------------------------------------------------------- -------------------------------------------------- --------------------•--- --------------------------------------------------------------------------------------------------------------------------...-------------------------------------------------------- ------------- ------------------------------------- -------------------------------------------------------------------------- -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- I hereby certify that I have prepared this applictiton and that the work will be done in accordance with San Joaquin County ordinances, State s, and rules and regulations the S Joaquin Local Health District. (Signed)------- �' -- ---- ---------------------------- By: --------=--------- -----------------------------------------------------------(Owner and/or Contractor) By------------------------------------------------------------------------------------------------------------------------------ -----(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 J -/,� - APPLICATION ACCEPTED BY----- - -'--------------------- ---------------------------------------------------------- DATE---------------------- - 4- -------------------------- REVIEWEDBY--------------------------------------------- ------- --------------------------------------------------------------------- DATE------------------------------------------ ----_---------- BUILDINGPERMIT ISSUED--------- ------------------------------------------------------------•----------------------------- DATE------------------------------------------------------------- Alterations and/or recom endations:- ------- ---- -._.. _. ---------------------- ------------ ,rg .---- ---- .- Z� 5 � hz ------------ - ------ -- __ c �fra_ --- - - --------------- -- ---------f` �" ------------ `3 -. w. 'T' ----------------------------- -- -- ------ ---------7-� 7G - /-i�� FINALINSPECTION BY:-- �------------ -----------_----------- 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 F.P.CC.