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FOR OFFICE USE: I APPLICATION FOR-SANITATION PERMIT Permit No. �_l'�.�_5 t ------------ -------------------'-- ------ --- - - (Complefe in Duplicate) Date Issued - -- 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 theewey k herein d r ed. This application is made in compliance with C y Ordinance No, 549 JOB ADDRESS AND LO ATION--n-o ---- ----- --- --_----- Owner's Name---- G-- i------------------ '------ ------- ---- -- --------------- ------ Phone._....._ -- - Address.---................. --------------------------- Contractor's Name__. ------- �---- ---- ----•--•-- Phone.' a fD Installation will serve: Residence [Apartment House L] Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __.l- Number of bedrooms __Number of baths _r__ Lot size _ �, �ir.t�t__________________ Water Supply: Public'system ❑ Community system ❑ Private,® Depth to Water Table4s,,ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel [:]• tSandy Loam ❑ Clay Loam P� Clay ❑ Adobe❑ Hardpan Previous Application Made: (If yes,date--------------------) No. New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ r TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200,feet.) I Septic Tank: Distance from nearest well--------------_Distance from f<;L�Indatio---_____----p__.--,Material_-..___.-__.___....__...___: � _--______- No. of compartments--------------------------Size--_ -----------------ft------Liquid deth---------------- ....__ Capacity------- ---------- ___-- I Disposal Field: Distance from nearest well-_/,:%---Distance from foundation---c^7_.__.Distance to nearest lot line.__-_____ { Number of lines 41" ..._ Lth of each le _ '_��__.__..Width of trench__ __ ___.'_ Type of filter of filter materlal_,/ _____.._----Total length___0,S-_____-----_________.____ (� Seepage Pit: Distance to nearest well.-/ fr m foundation_ _ ��. ______ _ � � '� ,,,�t__`_____.Distance to nearest lot line.r_-51`��___`__ .5 Number of pits.____�_____________Lining material_- ��, `t*Size: Dia meter__ ______Qepth__ `'' --------- a 5 Cesspool: Distance from nearest well-------------- from fori-detion--------------------Lning material---------------.-------______________- ❑ Size: Diameter------ ------•-------------..._."_ De Depth--------------- -------------------------..Liquid Capacity -----9als. 5 Privy: Distance from nearest well--------------------- �_ Qistance from nearest building----------------------------------------- Distance to nearest [of line------- 4-- , Remodeling and/or repairing (describe)- -�------,ei4/.11�----------•------- i ------------------------------•--------------'=------------------------------------•--- ------•--------'--------------------------------------------------------------------------- --------------------- f� + I hereby certify that I have prepared 44,application and that t work will-6e done in accordance with San Joaquin County ordinances, State laws, and rules an fations of the San Joh to Loc'al HealtltjDistrict. y `----•-------• �/...5 - p --- L1/-� ..t --------------- wn and/or Contractor) I (Signed) --r--- F �Z t - � By:--- -------- -------------------------------------- ------------------------(Title)---s ---------- [Plot plan, s owing size of lot, to ion of system in relation fo wells, buildings, etc.,4can be placed on reverse srde]� f. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ---------------------------------------------------------- --------------. DATE-..--3----'L-'6----- ----- ----------- REVIEWED BY-----------1---•-----------! - -- _ _ DATE---------------- ------------------------------------------- -------------------------------------- --------------------------------------- BUILDING PERMIT ISSUED----1 + 1 -------- -- ------------------------ ----.- DATE------------------------------------------------------------- .,�... , ..�..._.........`...�.. - - ----- ----,--_-------- �..------w...-.....�.--TM r AI#erations and/or recommendatrons:---`-'--------- - ------------------------------------------------------------------------------------------------ ---•------- .. ----------------------------- - ` E ------------------------ _--- _ -. - f ---------- ----- --- ---- .. t'-- =--------------------------------------------------- -----•------ •-•-------------------- ------ --------- I FINAL INSPECTION BY: ---- --- -- -- ---------- - ------------ -- ---- ------- Date---�'1`��{�-----•----------- ---------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th street Stockton,California Lodi,California Manteca,California Tracy,California F.P.C o. I