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� FOR OFFICE USE: . - ------------------- _, --•ley.� APPLICATION FOR SANITATION PERMITPermit No. -------- --------- --_.-_ (Complete in Duplicate) Date Issued ._! 3 --I---- _ This Permit Expires 1 Year From Date Issued Application is hereby made to the Sari 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 L CATION...-�_34 3 3 2` -..�'Q`---�" �� q /7 --4 - --- ---- �av-------------•--�--11(/_ �r1 t. � J Phone- �7f 65�---� Owner's Nama.__I/_/ _____._ Address------------••--2� Wil' ----------------------------------------------------------- •------------•--•---- Contractor's Name--------d,461.0TS Phone---------------•------------------- Installation will serve: Residence [R�Apartment House ❑ -Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ go 3!v Number of living units: _ Number of bedrooms _-%--- Number of baths -,Z- Lot size _____________________________________________________--_-.- Water Supply: Public system [!-Community system ❑ Private ❑ Depth to Water Table J-P 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 Ug-- New Construction: Yes .0'No ❑ FHA/VA: Yes ❑ No B 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 fo undatin :t Material:__��'° ��-- id de th_ SCapacity No. of compartments------�------------ Size-.--x ---`!i p-- Lqu �{ Disposal Field: Distance from nearest well-__— _ ...Distance from foundation-1_0__._---_..__Distance to nearest lot line___ ____________ Number of lines_2_�_.... ------------Length of each line--:590__e --- -- ------------- of trench---- - -------------------- W Type of filter material'�6 ___ .�L--_----_De Depth of filter material/k g Total length ----•--------------------- Seepage Pit: Distance to nearest well----------------------Distance from foundation_1_D__'_.:______.Distance to nearest lot line_- ..___------ 00 Number of pits._.�_i -.----------Lining material-.j 0-C k _.Size: Diameter-_-__r*3'�___..- --Depth__-___.��--------- ----- I Cesspool: Distance from nearest well_________________Distance from foundation--------------------Lining material------------------------------------- D Size: --_._._..____.___---_________ ___- Size: Diameter-----i----------- --------- ------ ----Depth--------------------- --------Liquid Capacity----- .--------------------gals. I -._Distance from nearest building �J Privy: Distance from nearest well 9------------------------------------------ ❑ Distance to nearest lot line------------------------ --------------------------- -------------- ------- Remodeling and/or repairing (describe)--------- ------------ ----------------- -------------------------------------------------------------•--------------------------------•--• I 1 -------------------------------------- r --•-------•----------------•----------=-----°------------------------------------------------- -------------------------------- -----------•--------------•------------------------------------------------------------- - O I--------------------------------------------------------------------------------------------------------------------------------------------------- -- Si ---------------------------------------------------------- ---- 1 hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County 'r ordinances, State laws, and rules an regulations of the San Joaq ' Local Health District. i - -------------------------------------(Owner and/or Contractor) ---- ---- -------- --�_ By:----- ---------- ----------------------------------------(Title)---------- ------------------- ----- - -------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). r- i FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -- ----- ------------------------------ ------------- DATE--,/1_`� REVIEWED BY--------------------- --- - --------------------------------------------------------- � - -------------- -------- DATE--- ---•------------ - BUILDINGPERMIT ISSUED------------------------------ -- ---------------------------- j---------------------------� DATE ------------------------------------------------------- Alterations and/or recommendations:' ' --------- ----------- -�� ---�-- �•- ------------------- --------------------------- ---------------- -------------------------------------------------------------- -------------------------------- r ----------------------------------------------- --------------------------------------------------------------- FINAL INSPECTION BY:_, t :,Date_9./ - _ i SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haselton Ave. 300 West Oak Street. 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California S F.P.0 d.