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FOR OFFICE USE: /G_'__ e--- -- ----------- - ----& -----------------------//-]�-------/((--- - ------------------ APPLICATION FOR SANITATION PERMIT Permit No. 1�� -------------------- - I l/I- ------------------ (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 LOCATION ----- 9�Z -• ------- ----- -----------------------r - --- tOwner's Name / / Lrr -------- ---- -- --- -- Phone "'✓------5 --- Address I W_ c9- .�LL - -- - -Y� .- -----------W - y-------------------------------------------------------------------------------------------------- Contractor's Name---__-Z1�-_C-------------S,47S - t ( C. - ----- -------------------------------------------- Phone- -- Installation will serve: Residence [ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ 7 Number of living units: l----- Number of bedrooms Number of baths /- Lot size ------ --r------------------- Water Supply: Public system 93- Community system ❑ Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 2--Hardpan ❑ Previous Application Made: (If yes,date______---___---- ---) No [Zr New Construction: Yes ❑ No [t FHA/VA: Yes ❑ No 9�-- 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------------------------------------------------ - C�/�," � No. of compartments-------------------------Size------------------------------Liquid depth-------------------------Capacity----------------------- Disposal Field: Distance from nearest well---NO------Distance from foundation---I-0__r------Distance to nearest lot line__S$7_1-..--. ®'" Number of lines-----------/---------------------Length of each line_.�_O� o' ,3-��---Width of french------1--/_--_---_.___-_--.-- Type of filter material--_-._/-Qu_c-/ ___Depth of filter mate ria l____-/-�_/i-------Total length_-_- Tv--2 i Seepage Pit: Distance to nearest well-------h/lD------Distance from foundation__--./_-q-------.Distance to nearest lot lin f.-�.-------_ �' Number of pits__-____1_-----------Lining material_-___A_O-CA(Size: Diameter__--- -_____--Depth---_2-S__----------------- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material------------_--_______-_---__------ ❑ Size: Diameter-------------------------------------Depth--------------------- ------------------ ----------Liquid Capacity---------------------------gals. Privy: Distance t> _pearest well---________________________________-_-.-----Distance from nearest building ------------------------------------- r ❑ Distance to nearest o - - ---------------------------------------------------------------- Remodeling and/or repairing (describe):---------------------------------------------------------------------------`:._:--------------------------------------------------- I----------------------------------------------------------- --------------------------------------------------------------------------------- -------------------------------------------------•------------------------------------------------------------------------------------ ---------------- --- ---------------- ------------------------------------------------------------------------------------------------------------------------------------- ------ 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 San Joaquin Local Health District. (Signed) , /---------------------------------------------------------- (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 APPLICATION ACCEPTED BY------' ,� ------------SA----- -P4- "��"�----------------- DATE---------------------- REVIEWED BY --- /- t'frr d- ccb+.�.---------------- DATE------------------- BUILDING PERMIT ISSUED------------------------------------------ ---------- -------�----------------- ----------- DATE_--------------------------- ---- --- -- Alterations and/or recommendati ns:-___-t____ S_44 r til ------- ----------=-mss-------- 4��K ct.r a� Bey' - � :--- ----- - -��- -�� f�- -_�� ,;- �-----�--------------------- ------------•--------_-�------------- ------- --------- ------- -- -- ---- ----- -------- - - ---- ---- ------------------------------ - - - - - ----------- ---- -- ------ -------- -- --- ------------------------ "G '� n-� ---------------- -------•------- FINAL INSPECTION BY:--------------- --- --- Date--------- ----- ------------------------- - J -WUI_N__L0CAL 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.CO.