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FOR OFFICE USE: o �`?,-4 91` ----------------------- 0:0.6 -------------------------- - __ _ ____._-_-__ APPLICATION FOR SANITATION PERMIT Permit No. ...........737..... ----- - (Complete in Duplicate) -------------__ This Permit Expires 1 Year From Date Issued 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 AND LOCAT , / -14z ....----- Owner's Name �f ?T-'--------------------- ----- Phone..........................--------- Address ---------------------------------------------------------------------------------------------------------------------------------------------------------- Contractor's Name---------------- �------------------•------------------------------------------------.......... Phone................................... Installation will serve: Residence W?"Apar#rpent House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _ __ Number of'bedrooms -A--- Number of baths -/--- Lot size -------------- ---------- Water Supply: Public system ❑ Community sy4em ❑ Private Depth to Water Table /4"ft Character of soil to a depth of 3 feet: Sand ❑ Gravel (] Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ZV---7`lardpan ❑ 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 public sewer is available within 200 feet.) Setic Ja k:, Distance from nearest welL_______________Dlstance from foundation--------------------Material.____________.___.__.___.___...__. ----- - ___. No. of compartments------------ -------- Size-----_------------------------Liquid dep`h----- ----- --------Capacity----------------- -- Disposal Feld: Distance from nearest well---%.��_Distance from foundation-_/`e___-___.Distance to nearest lot liner_'.__... ✓dip Number of lines_------- Length of each line---- of trench__ ._ g rr `/# ----------------------------- Type Type of filter material-, Depth of filter material-_- `-__Total length_-1_-l�_______________________P___-- Seepage Pit: Distance to nearestDistance fr fou dation__4_fQ_---___.Distance to nearest lot line_,/rL"'___-_---- Number ofp'ts_.._ ____.__ _Lining material__. ��_ <.Size: Diameter.J-J_..... ........Depth:;74_'_/0 n 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): �A� _ ""7 •11" ------------------------------------------------ ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. Si ned "' _______________________(Qji33M=Est/or Contractor) BY: — --`-------(Title)---- - - _.---- (Plot plan, showing size of lot, location of system in relati 0 wells, buildings, etc., can be placed on reverse side). %+OR DEPARTMENT USE ONLY 'APPLICATION ACCEPTED BY----------- - - ------------- ---------------------------- ------------- DATE-------- ------,- -- ---S _ ;REVIEWED BY------------------------------------------- --------------------------------------------- DATE------------------------------------------------------------ B�ILDING PERMIT ISSUED---------------- DATE - - - - --------------------------- l0 Alterations and/or recommendations:._____.._ . ,/ ,�__-� .._._C !, - - ____________________.._-----------_ ---------------------------------------------------•------------------------------------------------------------------------------------------------------------------------------------------------------------------------- -------------------------------------------------------.-.--------------------------------------------------•-------------------------------------------------------------------------------•----------------------------- X -----------------------.._.____.-.--_.-.-_..-.._._----_-_-__--_.-..-._--_______._____-._._________-.---.__-___-_-.__....__--_-__-_-__-.-_.-__--_-_-_-.--•-_-_-_--_--______.___.-___-__--._._.__.--__-____-------___-_.____-___.. _________________________________________________________________.__-.-.-..._._..._-__-__--.-________-______..-.----__--____.__.________--_.__-_..___.__--_..--_..-__.-_.--_______.___--__.__.._...____-..___-___._-._.___-._-- FINAL INSPECTION BY:----- �74t L------------------ - Date------- -- SAN 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