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FOR OFFICE USE: 9w _P --------------------------------------------------------- APPLICATION -FOR SANITATION PERMIT Permit No. ...ly%T__.. - ------------------------------------------------------- (Complete in Duplicate) a r Date Issued ___/ __Y/ ______________-__.---.-..-.--.----.--_ 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 app Icatlon is made m compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION----- Owner's Name--------- •/``_P rf _S- --'-'--------- ----- ---i ------ Address tP. I .fri_�'�1/.$/c--------------- '�{ Contractor's Name------1 __.t _e _!_V:. �� Phone_ fF.'_f^� -f�`� 7 Installation will serve: 'Residence Cg Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other 0 Number of living units: __l.-_- Number of bedrooms __3__ Number of baths _/!" Lot size ----�._7 0_--X.....f ------ ---------- r Water Supply: Public system K Community system ❑ Private ❑ Depth to Water Table -------- 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 W New Construction: Yes Q0 No ❑ FHA/VA: Yes ❑ No P? TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) i I `* �_ Septic Tank: Distance from nearest well-----------------Distance from foundation__'Zo-__-___Materi _ -al,___- f"- - .S�-_------------- . g[ No, of compartmelts--__-r_--, .-------Size=S-,�.k__X_j--�,---Liquid depth_-,�__.-'r-+--------Capacity_/ N� ,rs/ Dis osal Field: Distance from nearest well � Distance from found tion __ .`.__---.Distance to nearest lot line - ---. p Number of lines-___1_-__-___- alp ____ Length of each liner �SO�t�-(Q /idth of trench.._.._. . __..._____._ fi Type of filter material__ tp��t p -- length d Seepage Pit: Distance to nearest well_.__--------------Distance from foundation--------------------Distance to nearest lot line----------------- a ❑ Number of pits.......:.......... ;Lining material--------------------- -Size: Diameter__=-------------- Depth--------------------------------- t) Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining matei ial___._____--_..__.___________-.___.. Size: Diameter------- ------ --------------------De th----------------------------------------------------Liuid Capacity gals. V1 Privy: Distance from realest well----___------------------------------------------Distance from nearesf building------------------------------------------ F1Distance to nearest-lot line-------------- --------------------------------------------------------------------1--------- ------------------------------------------- Remodeling and/or repairing (describe)------- -------- ------•-------------------------------------------------------- � --------------------------------------------------------------•------------------------------------------------------------------------- ---------------------------------------------=-------------------------------------- I .� --------------------------------------------------------------- -----•------------------------------------------------------------------------------------------------------------- --------------- I 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 egulations of the San Joaquin Local Health District.. (Signed) 2e�---------------------------------- - ------ - _--_ .-_ _ O ner and/or Contractor (Title) -----°----- ----- -------- (Plot plan, showing size of lot, lots o� of system in relation to wells,-buildings;;-etc., canbe placed on reverse side). FOR DEPARTMENT USE ONLY �..- . APPLICATION ACCEPTED BY----------=------------------------ -- DATE-___ r -- --------------- 1 REVIEWED BY------------- - --- DATE-------- BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE------------------------------ -- ------- Alterations and/or recommendations—'----:--.----- - — ' -- ---------------- -------------------------------------------------------------------------------------- -----------------------------------:------------------------------------------------------------------------------• -------------- �_. ="------------------------------------------------ ---•- - . ,ter - ------------------------------ FINAL INSPECTION BY:r - -- -------------------------------- Date-../4- T ----- --- -------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1401 E.Na:elton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,Californla Lodi, California Manteca,California Tracy,California' F