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/FO�FFICE USE: 7 7�1 5----------------------- -------- Permit No. .. ---------------- o 0 __ APPLICATION FOR SANITATION PERMIT - - - -- --------------- (Complete in Duplicate) �� f ' r'� ,I Date Issued ___.__ __ S- j,'' _------------- 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. JOB ADDRESS AND LOCATION----- I-Q--S------------- a►f_~- --k -------.-_/ .---------------------------------;5.TKH------------------------------- Owner's Name---�i.S_ -r-----�--,m--r---- _1�I4_ {2•�--------------- -------------------------------------------- Phone_'1 t 3 e � Address------- ----------------------------------------------------- Contractor's Name------- lJ-----S-----------------------------------!��J------------------ Phone-A4 Installation will serve: Residence X Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ---I---- Number of bedrooms _'.>--_ Number of baths ---I---- Lot size .___'�_J �_--_._X-__I-�Q-'-------------- Water Supply: Public system 0 Community system [-IPrivate ❑ Depth to Water Table _6©_ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe [W Hardpan ❑ Previous Application Made: (If yes,date_`_-_r.-.-.-_---_-.) No 0 New Construction: Yes El No Qr FHA/VA: Yes ❑ Nom' N"'A TYPE OF INSTALLATIOND 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_K0.t4_E__Distance from foundation------4-01------Distance to nearest lot line_+rd__'______- RI 1EAST/n/C Number of lines------.._..(.._--_------___-----Length of each line..______(00�_____________Width of trench__-__-__ C 1�-._Depth of filter material----------I_I�.......-Total length_________-------------------��------ J �pV Type of filter material-S�-IQ.Q Seepage Pit: Distance,to nearest well---f40WE-----Distance from foundation-----I_Q-1-------.Distance to nearest lot line_--�T_'__...._ /STING Number of pits----_---�-------------Lining material&_1_0 5-__..Size: Diameter--.._Z, -.'.'_-.___Depth-__----._-___.3�5�---------- Cesspool�OJ� Distance from nearest well-_.--._-__-_---_Distance from foundation--.._---_-__--_:_Lining material.--_-_.-_-_--._______.___._.___ IA Size: Diameter--------------------------------- ----Depth------- --------------- ---------- --------F-Liquid Capacity---------------------------gals. Privy: Distance from nea'rgtt well-------- .--------------------------------------.Distance from nearest building-_--__-_--__-___________________--_-.. ❑ Distance to nearest lot line---------------------------------------------- -----------------•---------------------------------------------------- __ T� ------------------------ Remodeling and/or repairing (describe):_ _ -_-/�.Q--1�-------- ----- ---------glulf-TQ-0-1v---------------------------------------------- ----------------------•-------------------------------------- _________ _________________________________________________________:-___-.__-___-_____-__-_._.___-___-___--__--____.__--_____.__--___-____-________--.-__-.--__._--.-_-__.__-___-----_-___---.---__._ I hereby certify that l,•have:prepared-this application and that the work will be done in accordance with San Joaquin County ordinances, State laws,and rules and'tegulations of the San Joaquin Local Health District. Signed) C( r (Owner and/or Contractor] 4 By: -•-- - (Title) - - - - ---- ---- --------- -- - ---- - ----- --- (Plot plan, showing size of lot, location o__system in relation to wells, buildings, etc, can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-----C� 5--------------------------------------------------------------- DATE----�P_'_310-- ------------------------ REVIEWEDBY-------------------------- -------- -------------------•-------------------._.- DATE----------------------------------------------- ------- BUILDINGPERMIT ISSUED--------------------t------------------ --------------------------------------------------------------79 DATE------------------------------------------- ----------- • �R�e , Alterations and/or recommendations:_. _#_'Z.--QRS___---_�-_--_-- ,{ ----------------------------------------------------------------------------------------------------------------------------------------------- = ---------------- -- = -------------------------------------------------------------------------------------------------------------------------------------- --------------------------------------- ------------------------------------------------------------------------------------------------- -------------- ---------------------------------------------------------------------------------- ------------------------ FINAL INSPECTION BY:---- --------------;---- Date------ s--------------------------------- ----------- 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.