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PUK Ul•FICE USE: G--------- ---- ------------ APPLICATION FOR SANITATION PERMIT Permit No, 5L,9 - I - ------------- --- -- -- _ {Complete in Duplicate) = - --- --- This Permit Ex ires 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. ry JOB ADDRESS S AND LO.--'AW- A ION___"---� �J 7/[/ -•, -� . Owner's Name -fir = Pone*� ---- - hd r j Address.................. 2,0 ILI - Contractor's Name ,_------rY G : Nom_-. " C ''----------------- Phone!�� 9�-7 Installation will serve: �Re idence� � - --"- .. d ® Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel Other ❑ Nur'nber of living units:k_/---''Number of bedrooms _ Number of baths _Z__- Lot size __7,57A ��' -- ------ ' Wafer Supp ly: Public'system Community system [ Private [] Depth to Water Table -------- ft. i Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑Sandy Loam ❑ Clay LoamR] Clay ❑ Adobe [3 Hardpan ❑ FPrevious Application Made: (If yes,date._-----------.--.) No New Construction: Yes ❑ No ® FHA/VA: Yes ❑ NoX TYPE OF INSTALLATION AND SPECIFICATIONS: (Na septic tank or cesspool permitted''if public sewer is available within 200 fee+.) nt Septic Tank: Distance from nearest w�e',II_.___A--_-_-.___Distance from foundation_-_____--- 1�.. . --------.Material---------- -------------------------- ---------- I ❑ No. of compartments-.___---t..�---- -----Size_ -----------------------._Liquid depth-------------------------1 Capacity P Y --------- ---- Disposal Field: Distance from nearest weft_..,` ----Distance from foundation-/ --__-__.Distance to nearest lot line_•) _ ® Number of lines-__----/ . . _ -" Type of filter material__.9 # of each line----__-- ��-- --.Width th nc - Length .fid Depth of`fil'tar material_- �:? �) Seepage Pit: Distance to nearest well------- r7�,.%,:__Distance .l f1m foundation___ O_`__--_--.Distance to nearest lot lines.. 1" Number ofng material__jA ;� _ "-__--Size: Diameter ---. D ------------ ------- epth_--.��- 00 Cesspool: Distance from nearest well _______Distance from foundationLining material_- _-_.-._ -._--_._. El Size: Diameter- --------- ---------- --------- Depth- -• -------- ------------ --------- -----------Liquid Capacity---------#------ --------g Privy:. Distance from nearest well---- ------------------------------------------ --Distance from nearest"buil&g-f Y gals., ❑ Distance to nearest lot line.... -_ .__ ._ _ -- -- - - ------------------ Remodeling and/or repairing (describe):___. 4 .- -•Q �' ---------•-------------------------------- -------------------------------------------------------- �-.- I hereby certify that I have prepared this applica+ion and that the work will be done in accordance with San Joaquin County ordinances, State laws; and rules and regulations of4+fie"San aquin Local Health District. 111 (Signed)--•-7�-`rte --r --- Ci(�.S _ .rV-, O ner and/or Contractor) I - _{Titlep--- - _ Plot plan, showing size of lot, tion of system in relation to wells, buildings, a f'c., can be laced on reverse side). - -------------- FOR DEPARTMENT USE ONLY l APPLICATION ACCEPTED BY REVIEWED BY ----- - - --- -- ------------------------------------- r DATE-.------ - ---------------------------- ------------------ ------------ DATE•-----------•------ ------- BUILQING PERMIT ISSUED------••---------- ------------ ------------- ------- -- --------- ---------- ----- - --------------- DATE Al+era+ions•and/or recommendations:::_____.l-lQ-�� -- -------------------------------------------- ' -- ----- ---------- ----- ------------- ----- ---------------------------------------------------- --------------------------------------- ------------------------------------------------------------------------- , ,. ----------------- ------------------- --- - ---------------------------------- --------------------------------------- ---- FINAL INSPECTION BY---------------------- - Date SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 1. 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California