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K%FjtICE APPLICATION'FOR SANITATION PE mit No. ...1.. .(O S ' ANNEI) - (Complete in Duplicate) � �} This Permit Expires 1 Year From Date Issued Dote 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 ApFBLO ATION 6� -- ---------------- -------_-------------- G ' - - - Owner's Name---- - ----- -------- - -------- C1"t?'zA ---------- Phone.l Address-'._a-3------ - 4 . Contractor's Name..------. Phone._ +vt9/...G�-71i� Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other .�a Number of living units: ----- Number of bedrooms __ Number of baths oY---. Lot size ------- -- ------- Water Supply: Public system V Community system ❑ Private ❑ Depth to Water Table l- f" ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 01 Hardpan ❑ Previous Application Made: (if yes,date______..__---) No X New Construction: Yes jQ No ❑ FHA/VA: Yes ❑ NOR 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--_S" _..-.Distance from foundation.._/_0--------Material ----- --------- ." .............. No. of compartments....._-."_.�----- -"_Size------- .- Liquid depth---- ----S "__-_Capacity..... oo Disposal Field: Distance from nearest well---- istance from foundation----�.QA___1.ZDlstance to nearest lot line. (e Number of lines-_-_------------_1-_ ___..._.-Length of each line____�Q-�----. Width of trench.--.rz`Z. Type of filter material_.. -__Depth of filter material... :/Sotal length....--.`�" :: - .--_ Seepage Pit: Distance to nearest well tQ-Q �istance,fpro�m/foundation---1.0.. x..-..Distance to nearest lot ine-"..5 [a Number of pits....__"/_____-Lining material.-_tt->� ....".Size: Diameter-efn--k-to'kk Depth------- -- . Cesspool: Distance from nearest well._--------------Distance from foundation_. ......... Lining material... ❑ Size: Diameter. ------ --------- -----------------Depth---....--------- ------------------------------Liquid Capacity---------------------------gals- V t Privy: Distance from nearest well. ___-"_--- -------- from nearest building. ___ ----.----------------."..-.".." ❑ Distance to nearest lot line---- --------------------------------------------------------------------------------------- _....-----------------.._............. i Remodeling and/or repairing (describe):--'ate.✓--- -- --- --- ---------------------------------------------------------------------------------------- --------------- ' .............---------------------------------------------------------------------------------------------------------------- ------------------------------ --------.._.----- ---------------------------.... -------------------------------------------..-------------------------------------_............._..__..... I hereby certify that I have prepared this application and the+ the work will be done in accordance with San Joaquin County ordinances, Sta laws, and rules and regulations of the San Joaquin Local Health District. (Signedy- .. � - - _. (Owner and/or Contractor) --- By:-------- (Plot --- - . �frt.�v' (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-------- .Y------61-- ------------ REVIEWED BY........ - --- ----- - -- -- --- ------------------------ ----------------------------------------- DATE------ -----------.... .".-._... . ........- BUILDINGPERMIT ISSUED---------------------------------------------------------------.------------- ---. . DATE. _------------------------------- Alterati ..... ..-._...-..-_-- .... -- -. ------ -_ -" ... �c ----------------------------------------------------- --- ---- = --. 7-- - . - FINAL INSPECTION BY:--- "_..... . .. .. ... - Dat,._1 -- T - ------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Stmt 205 Wart 9th Strout Stockton,California Lodi,California Manteca,California Tracy,California ee s vcvieeo a av r.v.eo.an e�eo