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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT J Permit No. ....�d.D--.l.. ----------------------- I - --- - Date Issued .----------- (Complete in Duplicate] 7 � aG ......................._..._ __.____._._ . ______._._ 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 the work herein described. This application is made in compliance with County Ordinance No. S49, F JOB ADDRESS AND LOCATION ------------------ ------ ---------------------------- Owner's Namec �U' = �- '� ------------------ - -.. ----- Phone /�. ----- 4- - --- ---------- -- _. Address-----A5 _� ------ = _ . ------- - ------------------ -------------------- Contractor's Name----- '`. ----:, -----------�`4.-- ---- -- ------------------------------------------------- Phone----------------------------------- Installation will serve: Residence [Apartment House ❑ Commercial" ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of livingunits: ___ _+Number of bedrooms _ " • '�� ,� • { De th to Water Table �ft�"�tdobe -f��--p--�-------------------------- Water Supply: Publics stem Community system Private ' � � PPY� Y ❑ Y Y ❑ Numb❑er'of Paths _._.__._ Lot-size _ __ .�_ Character of soil to a depth of 3 feet: Sand Gravel Sand Loam Clay Loam Clay HardpanP ❑ ❑ Y ❑ Y ❑ Y ❑ ❑ Previous Application Made: (If yes date.-------------------1 No New Construction: Yes ❑ No [/, '`_FHA/VA: Yes ©' No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic +ank.or cesspool permitted if public sewer is available within 200 feet.) Septic T•arik: Distance from nearest well-----—--------Distance fro0f6uncafion-1 ----------- Material___`-------------------------_--_�-_.�. �r No. of compartments------ ------- ------Size--- ` fi_o =9 ._ ---.Liquid depth-----___---_.`-------A_Capacity./�.___- _✓ ' Disposal Field: Distance from nearest well__.......----------Distance fromfoundation: ------------ to nearest lot a_= Number of lines-�-----------------------*:__-_-Length of each line_____-�._�____f_________.Width of trench49.�''_._---_--__---- ----- Type of filter materia-_I:_cit ___.___Depth of.filternaterial--_ r-.`__:_1�.�____Total len thF•_ ,.:. % y, Y w.q., .,p .r'i-�f..:+n..•: -4- �,�-�"y..". k- V0 .g..t,�lr.��----------------------- Seepage Pit: Distance to nearest well-____________________Distance from foundation----------------------Distance to nearest lot line--.-_._.----_-.-- ❑ p 9 _Size:-Dia meter=--"`---- _---- --Depth------------------------------ Cesspool: ----------------•--------- - Number of ,ts...._________________Linin material_„`_."-^-- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material.....-------------------------------- Size: Diameter--------------------------------------De th------------------------------------ ❑ p ---------------Liquid Capacity - - ------- --gals. . Privy: Distance from nearest well _______________________-_°___._.__---___._____DJ stance from nearest building-------------------------------------------- ` ❑ _- Distance to nearest-lot line----- ------- -- --- --------- ---- ---- -------------- --- -- ------------------------ --------------------------------- 01-� i Remodelingand/or repairing (describe)-------------- --------------------------•-------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------•----------------------------------------------------•-----------•----------------- ------- -r,Q ----------------------- ---------- ------------------------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------ I hereby certify at I have prepared this a plication and that the work will be done in accordance with San Joaquin County jF ordinances, S+a+e I _ s!a ules and re i sof +h an Joaquin Local Health District. (Signed)------ --- ----------------------------------------------------- ---------------------- --------------------- ------------------ ----------------------(Owner and/or Contractor) l --(Title) (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY } APPLICATION ACCEPTED BY--- - -------------=------------------- -------------------------- DATE---- REVIEWEDBY-------------------------- --------- -------- -------------------- ---- - --------------------------------- DATE---•-------------------------------------------------------- BUILDINGPERMIT ISSUED---------•--------------------------- --------------------------------------------------------------- DATE------------------------------------------------------------- Alterations and/or recommendations:------ ------- ------ - ---•-------------------•----------------------------------------•---•--------•------------------------------ FINAL INSPECTION BY:-----!"[-- +� Date - 9Io..------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1801 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.CO. ,