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OFFFICE USE: �f Zej- Lov—O� _7 --- ------------------------ �_y_/��-____ ___/__ __ __-___-________ APPLICATION FOR SANITATION I- ..MIT Permit No. _.._.....7-..._...._._ -------------- --------- - tr` ---------------- (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 D LOCATION•____ _ �+ .c- �1__ �-_____ a� "_ .__.U�____ /I _ Owner's Name- - -------------- ----------- ----------------- Phone_ - -------__--- .Z-:7.� - - Address '� •--•-I--------------------------------------------------------------- --------------- ----------------------------------------------------- Contractor's Name--------- ---- ------------•-----------------------------------------------------------•---------------------------•--- Phone---------------------------------- Installation will .sseervee_:.c R.esid nce ❑ Apartment House E] Commercial E] Trailer Court E] Motel ❑ Other Number o It iving units: --- ---- Number of edrooms -------- Number of baths -------- Lot size --- _7 _�C� ___----------------- Water Supply: Public system ❑ Community system ❑ Private M Depth to Water Table _6--- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date--------------------) Now 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.) Septic Tank: Distance from nearest well---,S� -----Distance from foundation_--_fib---.-----..Material___--_._ ( No. of com artments.__a- _�_ o d ' e 4/ P ------- i,e-------------------------------Liquid depth-- �� - CapautY Tqa .... t IV Disposal Field: Distance from nearest well---7 ----_----_Distance from foundation_-1Q-------------Distance to nearest lot line___5 ___--___-_ N �] Number of lines_-_-_-_---__-------------_-_Length of each line---- of trench-___«--�_______ __..__.____. Type of filter material--�/C-_-----_Depth of filter material----L�'_`r-------_--Total length_____-LQU__k.10-'._.-___---_ b Seepage Pit: Distance to nearest well---------------------- from foundation--------------------Distance to nearest lot line-----._____---_ ❑ Number of pits----------------------Lining material-----------------------Size: Diameter-----------------------Depth--------___-___-____---_-_. Cesspool: Distance from nearest well-----------------Distance from foundation Lining material -__--------------_-_._______--- 0 ❑ Size: Diameter--------------------------------- ---Depth----------------- ----------------------- ----------Liquid Capacity----------------------------gals. Privy: Distance from nearest well _--. .----Distance from nearest building------------------------------------------ El ----------------------------------------❑ Distance to nearest lot line----------------------------------------------- ----------------------- -------------------------------------------------------- - N Remodelingand/or repairing (describe):---------------------------------- ---------------------------------------------------- ------------------------------------------------------------- ? -------------------------------------------------------------------------------------- ----------------------•-----------------------------------------------------------------------------'----------- ------------------ r --------------------------------------------------------------------------------------•----------------------•-----------•---•-------------------------------------------•------------------------------------------------- �l --------------------------- -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Ta' 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. (Signed),k____ _ .______----^_____rt---- -----------__-__- --_ _ (Owner and/or Contractor) --- By -- - ---�'' --------------------------------------------------------------------(Title)------------------------ ----------------- - ------------ (Plot plan, showing size -lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). F211 DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-- ------------- ---------------------------------------- DATE--§A- ` -------------------------------- REVIEWEDBY--------------------------------------------- ------------------------------ ----------------------------- ---------------._ 'DATE----------------------------------------- ------------------ BUILDING PERMIT ISSUED___________ __--------------------------------------------------------- --- -_------------ DATE_. . Alterations and/or recommendations:-tl,-f .'.5. -<_-,-; ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------ ------------------------------------------------ --- ---------------- ----------- - ----------------------------------------------------------------------------- ------------------------------------------------------------ (---(--_ Date ---C -_- ----- - -------------------------------------------FINAL INSPECTION BY:.---- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycame•e Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy, California F.P.CO.