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FOR OFFICE USE: 0 � )i, --------- --------------------- APPLICATION rOR SANITATION PERMIT Permit N . - ----------------------------------------------------- -- (Complete in Duplicate) l -------------------------------------- --------- 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 complian e with County Ordinance No. 549. JOB ADDRESS AND LOCATI �'�_1�=__._t_f--- 11_ ... �. Owner's Name------ ------------- L F=----------6-h-L--L--}---L-H-------------- --- ----------------------------------- Phone------------------------------------ Address - P. - CL._ /417 t = Contractor's Name----- O1--W-6j-r=--I ................. •--------------------------------------•----• ---------------------•---------------••------ Phone----------------------------------- Installation will server Residence [E[—Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __j----- Number of bedrooms . __ Number of baths _/_._ Lot size ____ ______________________ Water Supply: Public system ❑ Community system ❑ Private [-Depth to Water Table &Z ft. Character of soil to a depth of 3 feet: Sand 0"Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date--------- --------- No ET-_`-New Construction: Yes ❑ No �HA/VA: Yes ❑ No [a, 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 S _ C' -__Distance from foundation_._ _ _ ---__-_Material �L�_C h-C__1 ETI .,/_L-- No. of compartments-------- ---------Size_,_��_X16 - _`r____Liquid depth--------/Z_ --Capacity..../�--:_<_:_- Disposal Field: Distance from nearest well-_-_`�L_-.Distance from foundation____&-________.Distance to nearest lot line__________.__ ��_________________Length of each line--.----- ._----------Width of trench_.-___.__ �._________.__ [� Number of lines_____________ Type of filter material--- }L_S ------Depth of filter material_____/__,_---__------Total length___-____.-_,l`1._ ------'__._____._- Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line---------------_ ❑ Number of pits-----------------__-Lining material_____. __.__ ------- Size: Diameter-------------- --------Depth____________________________._ 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):------------------------------------------------------------------------------------------------ --° -------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ -------------- I hereby ce tify that I have pre ared this applig6tion and that the work will be done in accordance with San Joaquin County / d regul tiWns, the San Joaquin Local Health District. 'r- -''-- _- --Saedces, Stat laws and re a 3,I. -/ -- -� -_---.-_---Owner and or--Con+rac+o i By --------------------------------------- ----- ---- ---------------------------------- 'I> -----(Title)-------------------- (Plot --- - -- -- - (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR' EPARTMENT USE ONLY APPLICATION ACCEPTED BY----------I---I I -'- - ------------------------------------------------------------- DATE-------��= L - ---------------- REVIEWEDBY----------------------------------------------------------------- ----------------------------------------------------------- DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED--------- -------- ------------------------_-- --------------------------------------- ------ DATE_---------------------------------------------------------- Alterations and/or recommendations:---1 --- - 7-qN-6-___--,/!Y5�_-x_fLE�D----------------------------------------------................ ---------------------------------------------------------------------------- ----------------------------------------------------------- --------------------------------------- -------------------------------•----•-------- ---------------------------------STS". --- 'p\J ( s=+----------------------- ------------- ----------- ---------------------------------- ---- --- ------------------ -- --- -- ------------ -------------- ------ -------------------------- ------------------ ------------------------ -----------• ------ ------------•-------- ------ --- - ----- ----- -- ---- ------------------------------------ FINAL INS Date _' �`�6— - - - SAN JOAQUIN LOCALHEALTHDISTRICT 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.CC.