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FOR OFFICE USE: z4 `J- S ------------------------------ -= _ G APPLICATION FOR SANITATION PERMIT Permit No. __�Q._------ -. -------------------- - `��4/ (Completei in Duplicate) -- This Permit Expires 1 Year From Date Issued Date Issued --- .� ------ ------------- -------------------- Application is hereby made to the San Joaquin Local Huth District for a permit to construct a d install the work herein described. This application is made in compliance with County Ordinance No. 549. N/ .6��Ad JOB ADDRESS AN LOCATION / 1J Owner's Name---------- �....... IP^ -------- ---------------------------- Phone__9 /--'- 7 141/_0 Address --- -------------------------------------------------- ` Phone /J1 -- ------- - ------------------------- ------------ Contractor's Name__ ------------------ `._._ ------- ------ Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __,_-- Number-of bedrooms-- Number of baths _ Lot size ___-_------------------ Water Supply: Public system ❑ Community system E] Private 0-15e;th to Water Table 7z;lff. t Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 0-14ardpan ❑ Previous Application Made: (If yes,date----------------- No ❑ New Construction: Yes ❑ No146-. FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS. (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Distance from foundation----- / /P Septic Tank: Distance from nearest wel -__-__ D' /' A_____.MatenaL._.-_: No. of compartments__1 ----------------�ize4! _4'-1;_,___Liquid depth -._ i_ 0-__-°Capacity---_f4 Disposal Field: Distance from nearest well a� Distance from foundatio -----�. Distance to nearest lot line___ 'i -_--- Number of lines----- �ength of each Line__ ti! ._�. Width of trench ��- -'_ -'- �c�yC -__be th of filter material---�-�-f -Total length____ 1K Type of filter material f p �/ ___Distance' om f undetion___ .__-._ Seepage Pit: Distance to neare t well-t-0 -- -_-_- _._____ --.Distance to nearest lot line------ _ Number of pits._. -----.._______Lining. material..Ko-c. - --,Size: Diafneter..., -f� _Depth_-_- a `.__. Cesspool: Distance from nearest well-------- _-.t Distance Kv from f u idation-_-__-------------Lining material--- _-__.._-_.._._-_--__------ i ❑ Size: Diameter------------------------------------iDepth-----------------------------------------------------Liquid Capacity--------------------------gals. Privy: Distance from nearest well-. __ L Distance from nearestf building ___-- -- ----- -- ----- ❑ Distance to nearest lot line + _. L -- --- ----------- - -- - -- --- ------ ------ --------------- ----------- -- -- Rem d ing and/or re firing (describe):. �£.�- ' - - ° :fi ---------- ------------------------- -- -----�--/-,� D D /�' •� I hereby certify that I have prepared this application and that the work will be done in accordant with San Joaquin County ordinances, Stat laws, and rule and regulations of the an Joaquin Local Health District. s w (Si ned 9 ) Y ------ - -------- ------- Contractor) By:-----------f-------------------------------------------------------------------'-------- - (Title)--.--- ------------------------------------ -- ------ (Plot plan, showing size of lot, location of system in relation . n to w Is, buildings, a , can be placed on reverse side). FOR DEPARTMENT USE ONLY i APPLICATION ACCEPTED BY----------- - �=- .------------------------------------------- DATE----------�1J-------- Z'`C.4_---------------- REVIEWEDBY------------------------------------------- ----------- ------------- --------------------------------- ------------ ---- DATE--------- ---•------------- BUILDING PERMIT ISSUED-------- ---------------- ------------ DATE Alterations and/or recommendations: - / --- "` h '7�—� ------------- 1j__ - -- --- -------------- - ----- ---__ --- - 1----------------------------- --- --- -------- ----- ------ -- ------ - ----- - ------------------- ---------------I------- ------------------------------------ ------------------ --------------------------------------- ----------------------------- ------ --------------- - -------------------------- - ---------------------------------------------------------- --------------•--------- ------------------------ ----------------------------------------------------------------------- ----------------------- L-------------------------------------------------------- ----- - - ------------------------------------------- FINAL INSPECTION BY:....-- R. � - -�'�-"-=------ Date------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street 41 Stockton,California Lodi,California Manteca,California Tracy,California F.P.G O. I