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FOR OFFICE USE: 2/A /d yo _ Z_n-.-___ PLICATION FOR SANITATION PERMIT Permit No. - ------------------------------------- ------ ---------------------------- --------- - ` � (Complete in Duplicate) Date Issued -------------- -------------------.---------------------- r`V 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 LOC TION---�j'�-<---.�►al��'-----�G>r��fJEt"�---------------------------------------------------------------------------- ---------------- Owner's Name-------- ------V,i0�--(/------------------------------------- ------------------- ------------ Phone------------------------------------ Address---------_571?_ ------------------------------------------------ ----------- Contractor's Name--------- ------------------------------------------------------------------------•-----.__ Phone-................................ Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _/__ Number of bedrooms S... Number of baths _Z. Lot size ------__-___________________ Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table loe ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe[Hardpan ❑ Previous Application Made: (If yes,datelfl _"_ No ❑ New Construction: Yes ❑ No FHA/VA: Yes [ice'No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) i Septic Tank; Distance from nearest well/*AO�-__Distance from foundation--- "?----.-----Material_ep1�1-1_._c:-_e_-------A6 � P f '� X ' Liquid depths CapacitY ��----------- Disposal �--- Xl No. of com artments__._ -__.__/_____-___Size______________ ___ Disposal Field: Distance from nearest well./"- - -Distance from foundation- ----Distance to nearest lot line..... . ]I aY�jej Number of lines____*1.__ _f__ __ ength of each line_P4_._..4_C-;0 Width of trench- �_.s-------•____-- - dd Type of filter material/lxek Depth of filter material -_Xr_�r _ - Total length______ � __/______„__9 -_-s0._ -•_ Seepa a Pit:, Distance to nearest well_-___/*pQ _01_Distance fromfounndation_-----_/__ Distance to nearest lot line__- 4 F Number of pits__ __-__Lining material-___/16111!jSize: Diameter -----------Depth_a�--_-___________________._. _ Cesspool: Q Distance from nearest well.---------------- from foundation--------------------Lining material.........___________________________ N ❑ Size: Diameter- ----- ------------ ----------------Depth----------------------------------------------------Liquid Capacity----------------------------gals. V Privy: Distance from nearest well-----------------------------------------.-------Distance from nearest building-----___.__-________________________. _C ❑ Distance to nearest lot line - - - - -------------- Remodelin and/or re air' describe :______ - JC��? l!''_ ----_ ��/- _.�-..-_.._... 9 / P 9 ) - - - �/ /��• t�e.Fr.� �--/i .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, and rules and regulations of the San Joaquin Local Health District. (Signed)---------- --------1.62; - ✓z 6�! ---------- - -------------------- -------{�. r Contractor) BY:------------------------------------------------------------------------ ------- ----------(Title)--- -' - - - - (Plot plan, showing size of lot, location of system in ation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY-------e_- ------------------------------------------------------------------------------- DATE--------- - -f -------------------------- REVIEWEDBY--------------------------------------------- ------- ---------------------------------------------------------------------- DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE-------------------------------------- ------ -------------- Alterations and/or recommendations:. - --- - - -------------- ----------------------- ---- ---------- ----- ----- ----------- R -f - -, --._ �-� ----- ------------------------------ ---------------- ---------------------------------------- ----------- ------------------------ -------- ---------- ----------------------------------------- ----------------------------- - ---------- -------------------------- FINAL INSPECTION BY:.. / �"-'----------------------------------------- - 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 F.P.1:O.