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rUK llrrllL USE: = i- ---------------------��i/ d- a- =---G�----------------__ yz,_ APPLICATION FOR SANITATION PERMIT Permit No. --------------I------------------- (Complete in Duplicate) --- ----I------4- -_ -- --- 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.._- r`/� I l-,---�--------;_�'-=•-6----------- ---,5 .. Owner's Name 4/. =-------- -- -° �*------------ i/ one -----•-------- Address t_-� -------- -----. ` Contractor's Name---------5'4.L.L__c------------ ----------------------------- --------------- Phone Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court El Motel p Other ElNumber of living units: --- Number of bedrooms .�--- Number of baths I---- Lot size __.-._-//! �c _ Water Supply: Public system Community system [I Private El Depth to Water Table ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adob Hardpan ❑ Previous Application Made: (If yes,date------------------- ) No�( New Construction: Yes No ❑ FHA, k: es ❑ 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 _r�l2� Distance from foundation-.--- _. t_c_::__ ----------- ---- - ------- No. of compartments_____-_.` - _.___ E�__-_Li Liquid de th / q ` �y«------ Capacity l = Disposal Field: Distance from nearest well_k4*,t___Distance from foundation----tlL�-------Distance to nearest lot line_...-.�'_~`�-.. Number of lines________________ Length of each line A _____..,-`4?._�._.__..Width of trench.___-._��/_./� ;-; g Type of filter material.__.._ _�_ t._ j Depth of filter material____Al Total length--------- �_u_%--------__--- Seepage Pit: Distance to nearest well_,�.b!V. ,____Distance from foundation-------/&,.____.Dist�ce to nearest lot line--,,4-( Number of pits-------- -------- --..___-Lining material__..'-, .........Size: Diameter__._-. Depth_-___-_� •.. Cesspool: Distance from nearest well_._-_.______-_--Distance from foundation-------------------- material___________________________..---- ❑ Size: Diameter--------------------- -------------- Depth----------------------------------------------------Liquid Capacity----------------------------gals. pp�� Privy: Distance from nearest well___.__.___.,.,._____-____--_-__-_ Distance from nearest buildin qN ❑ Distance to nearest lot line_ ---_-___.___ g \' ----------------------------------------------------------------------- Remodeling and/or repairing (describe):------------------------------------ - - - ---------- - 6\ --------------------------------------------------------------------------------------------- ------------------------ ------------------ -------------------------------------------- --------------------------------------------------------------------------------------------------------------------------------------------------------------------- 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-Disfriet. t6 (Signed)---- -- -----�V_ � --- --- ------------------------------------------ - -----------------------------------(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). ------------------------- OR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY:_____..._ _----___ ------------------ --------------------------------------- DATE------v�- .`. . , REVIEWED BY ----------------------------- ---- - - - DATE------------ ---------------------------------------------- Alterations BUILDING PERMIT ISSUED--------------------------------------- ----------------------------- - -----------------------------------------------------------...-------------- DATE----------------- ------------------------------------------ A terations and/or recommendations:.__ - --•-------- ---------------------------------------------------- - --A� -pf�--�-�� -- -�-•-----�Qy��U --•�----'� --Ct�t1G�---�-`-`-- - t ��r_L / /----1---------- -------------------------------------------------------&NJO ------------------------------------ ----------------- FINAL INSPECTION BY: ------------ _�� „„ �'_,�� . - Date - --------------. LOCAL HEALTH DISTRICT 1601 E.Ha:ellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.00.