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FOR OFFICE USE: ----------------- ------ --{ ------ ------- p APPLICATION FOR SANITATION PERMIT Permit No. _1& -,.. . -------------------- --- - ------------------ -------- Date(Complete in Duplicate) .20 Issued 25�----.,��-- ' -------------------------- ------- 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. i This application is made in compliance with County Ordinance No. 549, JOB ADDRESS AND LOCATION.-__a__ I f------�f0-€�---1 -----------------------------------------•-------------------------------------------------- f�� xI Owner's Name--- .........-)_I + !9------- er__� --��--------------------- ----- - Phone---------------------- ------------- 1 Address---------_------------'r_. _-�-t- -------- --------------------------------•--------------------------------•--------------------------- ------ I �• 1 Contractor's Name A ------\ _ !)-�k --�------------- - - - Phone.. Installation will serve: Residence V,--<partment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ---/--- Number of bedrooms Number of baths _ --_-- Lot size __ Wafer Supply: Public system ommunity system ElPrivate F1Depth to Water Table -------- ft. t Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ardpan ❑ Previous Application Made: (If yes,date---------_------.__) No ❑ New Construction: Yes ❑ _No_D_FHA/_VA:-Yes.E1 TYPE OF INSTALLATION AND SPECIFICATIONS: ' (No septic tank or cesspool permitted if public sewer is available within 200 feet.) , Septic nk: Distance from nearest well__--"I--'-----Distance from foundation-_ _ _ � I p l No. of compartments.......t`��....__._Size___�`�.�_�f__�__.___Liquid depth__-�1z---_---------Capacity---- _______ ' Disposal Field: Distance from nearest well.....tT= .-Distance from foundation_____ ___._.Distance to nearest lot Number of lines- -------)----- _________ _____ Length of each line---_.9t`' Y Width of trench..� _ _ tf }� `` i �t 9 9 r Type of filter material__l �:__ cr __Depth of filter material__..__ __l f_-._Total length-_--7 ----------------- ------ Seep^a�ge It: Distance to nearest well---!�y____..__--Distance from foundation-_-- -----------Distance to nearest lot line---s -------- Le Number of pits-----I---------------Lining material_ Size: Diameter--_�_4�-r1_~~^Gept'f1' � 'j "_ ' Cesspool: Distance from nearest well----------- -----Distance from foundation --:-_-_.Lining material-._..._-__-_._.-______ ❑ Size: Diameter-------------'--------------------------Depth----------------------------------------------------Liquid Capacity- ------------------------gals. Privy: Distance from nearest well----------.- ______________________________Distance from nearest building-----_____- __---.--_-----___.--.._---- ❑ Distance to nearest lot -line--------------------------------------------- ----------------------------------------------------------•------------------------------- Remodelingand/or repairing describe :_...I---------- � �'�-.------_= --{,�- ) ) 7 r� ---A_21_��.11A_j/ p g {1 � -------------------------------------------------------------------------------------------------------- -------------- - --------------- -------------- _------ ------------------------------------ --------------------------------------------------------------------------------------------- .---- --ate 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 laws, and �rules and regulations of the San Joaquin Local Health District. i� .` ��-.- --------------------------------(Owner and/or Contractor (Signed)--------- , - = - - ------------ :__. �_ - ---:_ _ i / I By: -------- • , .� t --- � -----------------------------------------(Title)- � C_�1�-- �'-------..--------- (Plot plan, showing size of of cation of system in relation to wells, buildings, etc., can be placed on reverse side]. FOR DEPARTMENT USE ONLY �. 01 APPLICATION ACCEPTED BY_.._ - ----- ---"`-__-- :,__------ ----- DATE------- -- ------ �-~-------- REVIEWED BY----------------------------------- -------- ------__._.._. �.._.�4--_, �- -. 1 DATES::"- BUILDING PERMIT ISSUED-------------------------- ----------- -------------- DATE------------------------------ ------------------------------ Alterations and/or recommendations:.--`s �" ' r __Y � -_ '------------------------------=- _ ---------•-------------------------- 4 3 1 ------------- --------------------------------------_---------------------------------------.-----_---__.-------------------...------------------------------------------------------------.__.____._.____-_...-____.__.__---.----_.._.----- �- �J 1 FINAL INSPECTION BY:. -- - --------.-._ Date--I'l --....`�. ___-- SAN JOAQUIN LOCAL HEALTH DISTRICT ' 1601 E.Hoselton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California {