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FOR OFFICE USE: \k . ---------------�'`� \ 8�le _______* APPLICATION FOR SANITATION PERMIT Per No. .._�j..._......_/.... -------------------------------------- ----------------- (Complete in Duplicate) Date-Issued _-.-.___---_-----__--_--_--.---_-_-- ------------- 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. This application is made in compliance with County©©Ordinance No. 549.. / JOB ADDRESS AND`LLOCATIOK - t� � -P_----- P. L-_.f. .E. -./7'�----------------- --------------------------------------------- Owner's Name-------fT/ 1.'�1 _ .A_1461016-e..--- rN?-`,1/, Address-----------------------7.. ---------99---9--------------SSI., tE�1�'�✓ -----------------------------------/---------------------- Contractor's Name------ l t' / '�.r�,l 'n. ------- e-•-----------• Phone._��6P_Q Installation will serve: Residence [)''Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _./--_ Number of bedrooms _- Number of baths ._r.. Lot size ----- DD , /DD___'_________________ Water Supply: Public system [[Community system ❑ Private ❑ Depth to Water Table A4 ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam [ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date--------------------) No R' New Construction: Yes ❑ No ❑`FHA/VA: Yes ❑ • No [t— TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well-----------------Distance from foundation--------------------Material------------------------------------------------- El ----.--_-_--_----.----- _--_-----------_--.❑ No. of compartments-------------------- -----Size-------------------------- -----Liquid depth-------------- -----------Capacity----------------------- Disposal Field: Distance from nearest well-----------------Distance from foundation....................Distance to nearest lot line--------------_- 171 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 fr m foundation_.��._...Distance to nearest lot line_ --_._ �� Number of pits._.---/---- ------Lining material ---Size: Diameter...-�.__j#*--- _--Depth--- ..5. l__-__..-- 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------- -------- ---- -----------------------------------------•-•------•--------------------------------------------------------------- Remodeling and/or repairing (describe):_-____ ._ _-__-.l l.,S__T, . ,il -------._-------------------- s: -------------------------------•---------------------------------------------------------------•-------------------------•--------------------------------------------------------------------------------- ----------- ------------- ---------- ------------------------------ ------------------ ------------------------------------------------------------------------------•---------------------------------------- --------- 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, a d regulations of the /San Joaquin Local Health District. (Signed)----------------------------- ,CQ11-. ./7!-- �"� --------------------------- ----- (Own and/or Contractor) By:----------------------------- ---- ..tom..—-------------- ---------------------------------(Title)---- - r ......... .. . ...... . (Plot plan, showing size of lot, loca+ion of sys+ in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY_----------Ce---------------------------------------------------------------------------- DATE------- 9 's ----------------------------- REVIEWEDBY--------------------------------- ---------- ------------------------------------------- --------------------------------- DATE------------------------------------------------------- BUILDINGPERMIT ISSUED--------------------------------------------------------------—-------------------- --_------------ DATE-----------------------------------------------------•------- Alterdos and/or recommendations------------------ -----------------------------------------------------------------------------•---•-----------------------------------------_.....---------• ---------------'e---`1 ---7/1- ---- -------------C -----------------------------------------------------------------------------------------------------------------•- ----------------------------------- ------------------•-------------.---------------------------------------------- --------- ---------------------------- --------------------------------- (J� Date l� �5-_------- ------ FINAL INSPECTION BY:.._--------C-. / 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 F.P.CO.