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OFFICE USE: -- - ------------- 4a __-----_--------------------------------L'_4.5_ APPLICATION FOR SANITATION PERMIT Permit No. --------------- --------------------------------------- (Complete in Duplicate) --------------------.--- This Permit Expires 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. JOB ADDRESS AND LOCATION_ ---------------------------------------------------------------------------------- Owner's Namep. r� --- n � Phone----•----------•--------•----------- Address-------- 1�G. �4_10__`:17�11Mks;w;��- - '�' ContractorsName-----------/ -------------------------------------------------------------------------------------- Phone------------------------•---------- Installation will serve: Residence [P�partment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ o � Number of living units: -_/__ Number of bedrooms _l'Z- Number of baths __�._. Lot size ., _/ZEt,�_ ___________________________ Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table .46f ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe [L;/Hardpan ❑ Previous Application Made: (If yes,date--------------------Y No &" New Construction: Yes ❑ No �HA/VA: Yes ❑ No [j;_ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Teke Distance from nearest well_________________Distance from foundation__---.---.---_-_-._.Material---------------------------___---:___-_--__.----. No. of compartments------------------------Size--------------------------------Liquid depth-------------------------Capacity-_---------------_-- Disposak 6Fieo: Distance from nearest well_________________Distance from foundation--------------------Distance to nearest lot line-.•__.____---.__- � 5�� Number of lines-----------------------------------Length of each line------------------------------Width of trench---------------.___________________ Type of filter material-------------------------Depth of filter material-----------------------Total length----------------------.-_____-.-----.-__-_ Seepage Pit: Distance to nearest well____ -_-_____Distance om o n ation__Its�__-A419 -___.Distance to nearest lot line__... Number of pits_._._,*-.-___-___Lining maprial_ _ � �-- ize: Diameter___..-��.-_-_Deptho7�/ ,�FiIC<- Cesspool: Distance from nearest well--._---_-___.-_Distance ro oundation--------------------Lining material------.----------------------.___--__ ❑ Size: Diameter------ ------------------------------Depth------------------------------- -------------------Liquid Capacity --------------------_--gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearett building----------_________________-_--_-___ ❑ Distance to nearest lot line.------------ --a - - - - �i%'� w l Remodeling and/or repairing (describe)--------------- ---- - ---- - --- -- ---- F----•---------...-------------•---------------------------•-----••-•--• ---------------------- -----------------------------------------------------------------------------------------------------------------------------------------------------------------•---------------------------------- 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, (Signed) 'ny �towellis, • (ev�"= or Contractor) By:----------------------------------------------------------------------------------- - -----------------(Title)--- i{ '+�/ - ---- -- (Plot plan, showing size of lot, location of system in relati buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BYcli7---�----------------------- ------------------------------------------- DATE------ REVIEWEDBY------------------------------------------- ------- -----------------------------------------------------------------------... DATE BUILDINGPERMIT ISSUED----_-------------------------------------------------------------------- -------------------------- DATE---- Alterations and/or recommendation :._-__-__--_-________ ---------------------------------------------- G ,✓� ---- - - - .-------- -------------------------------------------------------------------------------- ----------------------------------------------------- --------------------------------------------------------- ------------------------------------ ---------------------. ------------------------------------------------------------------------ ----------------------- ---------- -------------------------------- -------------------- - -------- ---------------------------•----------------- ---------------------------------------------------------------------------- FINAL INSPECTION BY:.---------jF� -- - - Date y /,5-�✓-C-"4- -- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haxelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.CO.