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FC .JSE:_ ----------------- .:��- . APPLICATION FOR SANITATION PERMIT Permit No. _42_2p. -----------------------II (Complete in Duplicate) Date Issued This Permit Expires 1 Year From Date Issued Application is hereby made to th 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. E� +" _ "'"'r"""I ate.' JOB ADDRESS AND LOCATIO - !7�% = L' -0.... r `-�+------=�=Y =c----5 XT 1\1--------------------'---- p Phone. ------------------------- Owner's blame �i o-s��-----•--_.I o�_E-1-4-� -;,----,_-------- -- -- Address.----:---=--------=--�'��•--�'::./. ' BOX_-----_-� --�.r.��.-----`------ _- C ---�~- -----:---=-------'----- Ii ' A_R�-I_ Phone Contractor s Name-.__--•- -' _ �----- -----'----------- - --- ----- li Installation will serve: Residence Er Apartment House ❑ Commercial ❑ Trailer Court ❑nMotel ❑ Other ❑ Number of living units: __�___. Number of bedrooms Number of baths", —Lot size _/l�z Water Supply: Public system El Community system ❑ Private Depth to Water Table -4Q ft. Character of soil to a depth of 3 feet: Sand Gravel ❑ Sandy Loam ❑ Clay Loam 1] Clay ❑ Adobe ❑ Hardpan ❑ 4 Previous Application Made: (If yes,date___ - - ) .No Ell New Construction: Yes E] No ff HA/VA: Yes ❑ No 6TYPE'0E-INSTALLATION-;AND SPECIFICATIONS {No septic tank or cesspool permitted if public sewer is available within 200 feet.} b Septic Tank: Distance from nearest well_-_--_ ----Distance from foundation-----------_------,Material-------------------- ------------------------- .__E. fM No. of compartments------. ------------ Size ` - Liquid depth Capacity ---ield: Distance from nearest well.... 0---.-Distance from foundation----A7--------.Distance to nearest lot line.__,S_ } i Number of lines--_.-----2------ ------------Length of each line-70-4, 357l --_Width of trench_... _-_ ----..--4____-_-- s)(1�vr4 6— Type of filter material-- �. �' ..__Depth of filfe� material.._.!- ---s�--- -Total length__.._-____--1_...> ---------------- Seepage;'Pito Distance to nearest well- _--.-__-_-_-Distance from foundation--------------------Distance to nearest lot lino:_.___:._____ -. ElIl rt Number of pits--- .---------Lining material--=--------'--_'-;-----Size: Diameter-----------------------Depth--------- ------------------;alp li a Cesspool,: Distance from nearest well-----------------Distance from foundation....................Lining material---._.f_.y_._.----------.----.-.-__-.. ❑ Size: Diameter - Depth = ------------------------- -------------Liquid Capacity....---- gals. Privy: I Distance from nearest well_...-.------------------------------ --_-.-Distance from nearest building.---------:----------------__.___.._-.-.-. ❑ Distance to nearest lot line-------- -- --------------------- - ----------------------------------- --------------------- ----------------------------------------------- - - Remodeling and/or repairing (describe):_------APP)T--�LQ/ .-----gXL T"L_ �------eS -- _------------------------� l ----- ----------------------------------------------------- ------------------------------------------------� ------------------ .— �e+ ---------------- ---------------- -.-.---_--- f __________________________ _ �I ^ -------------------'------ I I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County 0 ordinances, S laws, and rules an regulations of the San Joaquin Local Health District. ,. (Signed) = �1," - - -- - -- ---- -----------------------------------e __ �- r —� r � Owner and or Contractor ,. _. --- . ----------------------------- - - (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 ft pp --------- DATE-- `� I' , APPLICP,TION ACCEPTED .BY----- -�-�i--ice-� •�--�-�-:------ --�--�-------------J----------- ----�--/r---~----- '-------------- ! REVIEWED BY------------------------------ ----- ------ --------------------- -- ------ ------------------ DATE BUILDINGPERMIT ISSUED--.-..------- ----------------------------- ---------------------------------------------------------- DATE------ ------------------------------ ------------- Alterations and/or recommendations:.=----- ,---- - -----------------------------------=---------------------------------------------------------------------------------- -----=---------- Il ( - . ...... .. - ------------------------ - ------ -- -- --------------------- ---------------- ---------------------- I ----------------------------------------- I FINAL INSPE� .. ----- -- - -- -- Date----------- -------------- ................ SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi, California Manteca, California Tracy,California I[ I F.P.CC.