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FOR OFFICE USE: ------------- ------------ ----------------------------- ----------- ----------- ------------- APPLICATION "FOR SANITATION PERMIT Permit No. .� ------------------------ - .", __ _0------------- This-Perm (Complete in Duplicate) Date Issued --------- ------------4--w-- ----------- it Expires 1,Xear 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 AND LOCATibN..... ------av-ex.)--- Owner's Name-------------9-ZP-4 ---------- ------------------ ----- --- - --------- ; � ------_. .. . ...... Address..................... ��g4 -----------/---------------------------------------------------- Contractor's Name------ s -- ---- ------- ----- �_ ----•-- ---- -------------------------------------------------------------.. Phone_.............--------------------- Installation will serve: Residence [Apartment House E] Commercial n Trailer Court [:] Motel E] Other F1 Number of living units: _/_ Number of bedrooms Number of baths _/__ Lot size ..7 XeZeJ4 7 ---------- ------------ f_______________________ 1 Water ----------------------- Water Supply: Public system E] Community system F-l 'Private Er-Depth to Water Table/,0.- ff. Character of soil to a depth of 3 feet: Sand E] Gravel Ej Sandy Loam lay Loam Ej Clay E] Adobe C] , Hardpan E] �" Fe—vi6-ui'AO-Pli6�ition�Made:- If ❑ �-FHA/VA: Yes-Dv--No-[;]�\ 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_-____.-_______Distance from foundation-------------------Material No. of compartments---------- ---------------Size------------------------------Liquid depth .--------------.--------Capacity------__ ---------------- Disposal Field: Distance from nearest well--- --'.--Distance from found, ation.._,/R_.!P.........Distance to nearest lot line--- _ Number of lines_____.!:-_-___.____- ---------Length of each line-,1_41-021--------------Width of french - --- ----- --------------- Type of filter material___!;�e elf---Depth of filter maferi,l___/9------------Total length-------------------Z _d � ------------ Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line--------------_- El Number of pits._____._._________Lining material-----------------------Size' Diameter_____________________Depth______________________-_- Cesspool: epth--------------------------------- Cesspool: Distance from nearest. well-----------------Distance from foundation--------------------Lining material_______..__.________.__---____. ❑ Size: aterial--------- ----------------------- Size: Diameter------------------------------ ------.Depth.-------------- --------------------------------Liquid Capacity--- ------------------------gals. Privy: Distance from nearest well--__._--____________._____---------___'______Distance f:rom, "nearest building____________________________-_._-____-- 171 Distance to nearest lot line-"------------------- -- - A Remodeling ine_"-------------------- Remodeling and/or repairing (describe):----M_J -- _;#------ ----------- A-----T177------4PR ------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------ri-k-ip--------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------- ----------------------------------------- --------- -------------------------------------- -------I-------------------------------------------------------------------------------------------------------------------------------------------------I------------ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, S ate laws, and r lesnd regulations of the San Joaquin Local Health District. 4� t -d g ... Signe ... --- -- ---------------------------------- -----------F77(0whir and/or CoWaEfor) -e .................... -----------------------------(Title)---- By:--------------------------------------------- s (Plot plan, showing size of lot, location of system in relation wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--- -------------•------------- -------------------------------------------------------- DATE----------------- REVIEWEDBY-------------------------------------------- --__-------------- ----------------------------------------------------------- DATE-------- ----------- -------- ---------- BUILDING PERMIT ISSUED-----------------•------------- - - - DATE - - f A terations SSUED-------------------------------- Alterations and/or recommendaf ions:---------- ------------------------- ------------- ---------- -----------------------I------------------------- -----------------I--------------------------------------- --------------- -------------------1.......... 1. ................ ------------------- ------------- ------------------------------------------------------------------------------------- --------------- --------------------------------------- ------------- -------------------------------------- ----------- ------- ------------------- --- -- --- - -- - - -- - -- - ---------- ---- -- --- - -- - - --- ---- -- --- -------- - ----- --- ------------- Z----------------- FINAL INSP ------------- -- --- ------ ---- ---- - Date............. ---- ------- ----------- ------------ SAN JOAQUIN LOCAL HEALTH-12115-TRIG-T 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.1213.