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FOR OFFICE USE: &77= ------------------------ ------------- ------------------- --�� __.__._____-._. .__ -___ (�_..__.1�.' n APPLICATION FOR SANITATION PERMIT Permit No. ---------------A 0---kid (Complete in Duplicate) This Permit Expires 1 Year From Date Issued Date Issued Application is hereby made fo the San Joaquin Local Health District for a permit to construct and install the work herein described, This application is made in compliancewithCounty Ordinance No. 549. JOB ADDRESS AND LOC TION__..L- ,-------- -------------------------------------------------------------------------------- Owner's Name- Phone ---------------------- - Phone-,----------------------------- -- 04 }, I Address - - -------- -- -------------------------------------•--------------------------------------- Contractor's Name_ one °t ------------------------ Ph Installation will serve: Residence A arfinent House `E. r f (�' p ❑.•Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of livingunits: Number of bedrooms _ 5 �'' ---- - Number of baths ---- Lot size Q_X_ ---------------------------------- Wafer Supply: Public system Community system ❑ Private ❑ Depth to Water'Ta6I1 ,0.:V_TT.` Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay LA m ❑ Clay [❑ Adobe �F brdpan ❑ I Previous Application Made: (If yes,date....................) No . NewConstruction: Yes ❑ No g-�7HA/VA.;Yes ❑ No 0� ! TYPE OF INSTALLATION AND SPECIFICATIONS: 9 1 (No septic tank or cesspool permitted if public sewer is available within 200 feet.). h0t� No. of compartments-------------- ----= -----Size---------------�-�'-��------ -----Li Liquid d'epf---.Material r � Septic Tank: Distance from nearest well-----------------Distance from foundation---------_- #h Ca t ! t q p. patty.-•-------------------- ' DisposaLField: Distance from nearest well_________________Distance from foundation--------- -----------Distance to nearest lot line---------._-_____ Number of lines-----------------------------------Length of each line--------------------1_.,_.---.Width�.of,trench fi - y. Type of filter material-_______________________Depth of filter material----------------------- length------------------------------------------ Seepage --__._______-_ ________---_-________-_ (, Seepage Pit: Distance to nearest wall____"__ _-------Distance from fo dation_ (�C____-Distance to nearest lot I' e_ I Number of its-.-. __ - p ___-______-_Lining material_ Size: Diameter---? Dep}h, Cesspool: Distance from nearest well? --�Distann from foundation____________________Lining material-------------------____---_____._-__. ❑ Size: Diameter - ------.Liquid Capacity- -------------------•------gals. v ----------- - - I Priv Distance from nearest well-________________ e�t__--___.-.____ Distance from nearest building--------------------------------- rest _--.______-._________ _ ❑ • F Distance to nearest lot line F Remodeling and/or repairing (describe)_________I---------- ------------------------- ----------------------- ------------------- -- f } r -------- ----------------- I hereby certify that I have prepared this application and that the workwill be done in accordance with San Joaquin Count ordinances, State laws, and rules and regulafions of the S Joaquin Local Health District. (Signed) - --- - �__ ---- -- --------------------•-------------- (fir Contractor) 1 ! Sy:------------------ •------------------------------------------------------- --- --- y (Title)-- (Plot Title)-(Plot plan, showing size of lot, location of system in r a n to wells, buildings, efc., can be placed on reverse side). 'h FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---------------------- �'�-- -------------------------------- ------------------- ----- --- DATE------ - --- - -- -REVIEWED BY-------------------------------------------------- -------------------------------------------------------------I-----------BY-------------------------------------------------- ------------------------------------------------------------------------- DATE �• _ --- ----------------- - ---------- BUILDING PERMIT ISSUED • -.._` � oT r .ori DATE. Alterations and/or recommendations - -----------------------------------------------------------------------------------...•------------------------- -_..•-----------------------------------------------------------------.--- - - - - - .................. ------------ -------- - --------------------------------- ----- ----------------------------------------------------------------- ----------------------------- - --J �G FINAL INSPECTION BY.-..-.,- ----- ---- -- �— - ---------- Date---------- .----------- = SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 5.• 12%4 S�ycamore Street 205 West 91h Street Stockton;C_aliforn;c Lodi,California Mpnteca,California Tracy,California F.P.Co.