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FOR OFFICE USE: i / (: &7- APPLICATION FOR SANITATION PERMITPermit No. .C.1c7 ----------- This Permit lCCpm l 1 Ye ete in uplicate)---------- - 4 - -------------- r 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._ -------- --.•------------- XeV7 ----->r/ G� --_ Owner's Name _ C ------------------------------- Phone,jfp-�- ---------•---- Address---------------------- i -- --- -------- 1------ -------------------------------------`�� " Contractor's Name-----...= A f # ---- --•- --- Phone-------- ----� Cr.- fo�, .._._� .1:_ �_ ......... - - - - ------------------ Installation will serve: Residence'''Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _-_. ,Number of bedrooms _. Number of baths _f Lot size --Wel-Its ---------------------- Water Supply. Public system ❑ ' Community system ❑ Private fj Depth to Water Table Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: [If yes,dateA "_..__.,_'1' No`[�-}" New Construction: Yes E] No [3--FHA/VA: Yes ❑ No [ " r TYPE OF INSTALLATION AND SPECIFICATIONS: [No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: NoDistance from art nearest well i -Distance from foundation__4_--___________-Material-___________________________________________ r v3� 4 , Liquid depth-------------------- ----Capacity----- ----- - ----- Disposal Field: Distance, rom�nearest'weil: .D__..._.Distance from fo` p - undatiori_:: 1�_ ___..Distance to nearest lot line_ �1 :_�_ Number of line`s - ____-- .------ ---Length of each liner_ ti_ _ --------- ?�tl�Y trench.------ 5x ----------- •--- G .a Type of filter material_____ .if ._Depth of filter material__/X�t---------Total length_"77� ------------ , i E Seepagg Pit: Distance to nearest well._/46?jP_-------Distance froj foundation-.�&_r___ Distance [+� : to nearest lot line- �� ---- I-/ --Number of pits -----------Lining material._-S �;�Size: .Diameter.� ----_ _ De th_ _ -- -----------__-- Cesspool: Distance nearest well.................Distance fromfoundation....................Lining material---------------_---.___:------------- s ❑ SizeDiameter Depth ----------- -------------------------------------Liquid_Capacity-----------------------------gals. Privy: Distance from nearest well-___...._-___.._________-----------------------Distance from nearest building_________________________________________ V v ❑ Distance to nearest lot-line__.._"". _ Remodeling and/ortrepairing (describe):---___.._X_ -------------------------------------------------------------------------------------------------'----------------------------------------------------------------------------------=-------------------------------- ' ------------------- -------------------------- ---------------- ------------------------------------------------------------------------------------------ -------\1----------------------------------------------- i ------------------------------------------------------------------------------•------------ --------------------------------------------------------- -------- -------------------------------------------------------- -- -- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State la and rules and regulations of the San Joaquin Local Health District, �r ------- - --- - --------------- and/or Contractor) (Signed) ------ ---�- �. i _ �z By:------------------ � --- - - _- -------------------------------------------------------(Title)----- / ------..._..---------'----- (Plot plan, showing size of lot, location a system in relation to wells, buildings, etc., can be placed on reverse side). rte. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---------- "/_ L-- ----------------- -------------------- a --- DATE----- REVIEWEDBY----------- -------------------------- -- ------- ------------- - ------------------------------------------ •. DATE------------------•-------------------------------------- BUILDING PERMIT ISSUED--------- DTE---- ------ . ' S _.___ -__ _ _�Alterations and/or recommendationr~ ____,� � ___- . 7 __._ ----------------��---- -------------- ----------- .-�----- .----------- - ---------------------------------------------- --- ------------ FINAL INSPECTION BY:.--- _- ---- Date I S JOAQUIN LOCAL HEALTH DISTRICT f 1601 E.Ha=etlon Ave. 30 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California t; F.P.0 0. L ,