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FOR OFFICE USE: = Permi# No. - ..............APPLICATION FOR SANITATION PERMIT --------------------------------------------------------- - -------------------------------- -- --------------------- (Complete in Duplicate) Date Issued _ ':• `'�-'--• r _-----.--- This Permit Ex Tres 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 compli n•�cwith County Ordinance No. 549. ; 7 ----- -•--- i JOB ADDRESS AND LOCATION-_____ t .:= = -• = �.Cr_:'_ - ---._ Owner's Name-------------- ------------•---------••----------•------ Phone Paio Z11lC�'!Z -----•------•-• --------------------••- -----••--Address----- -----Contractor's Name _..__ _sa__(f'/ .-•- ---------•--- Phone.................................... M Installation will serve: Residence D' Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ �-1 ` Number of living units: ___ Number of bedrooms _a___ Number of baths ._f___ Lot size ------yV 5--X----•�� F Water Supply: Public system .Q Community system El Private r7Depth to Water Tabe ---•--- ft. Hardpa Character of soil to a depth of 3 feel: .Sand E] Gravel F1 Sandy Loam F1Y:Cla ❑lLoam ClayAdobe B.- No Q Previous Application Made: (If yes,date---------------------1 No F1New Construction: Yes [I No ❑ FHA/VA: Yes ❑ .,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._/�olDis#ante fr�� founclation__._/61--------Material!_�_ ?Z�t[ --.✓-�oc---••-------• [� - ,r No. of compartments---------'Z-------------Size--------6-�----X--�e__,4,4Liquid depth---------- y---------Capacity-==---.4:W Disposal Field: Distance from nearest well-N��G�Distance from foundation..-Q0/.---•-•Distance +o nearest lot line--:__-_ ------ Number of lines------------- ----tt- Length. of each line----------1 n- -----•Width of french---------- -----------•-- m Type of filter mat---- �f------- -_Depth of filter material-------IV .......Tota length_____________1_9Q____:_____-____--.__ Seepage Pit: Distance to nearest well ---Distance from foundation____/0__/-' --.Distance to nearest lot line_.._------- Linin materiae- -_Size: Diameter------ -��----Depth----------------- ------------ -------- -5-----------•---- I ® Number of pits------/-_____- g Cesspool: Distance from nearest well-----------------Distance from-.fo.undation___ _________.Linin material__.__.__._.___.___._:__.__..__`._.-. �{ Li uid Ca aci - -------•----------- gals. Depth------------------------------------------------- q P _ tY P ❑ -_ . __ Size: .Diameter_-=_-:,,.----------------------------- t € Distance from nearest well-----------------'--------------------------- ---Distance from nearest building-------------------- ••---- ------ Privy: -- ' Distance to nearest lot line------------•--------------------- ----•------ ----•-----•- -------------------------- �3 Remodeling and/or repairing (describe):----------------------------.--------.------------.-_ -------------------------------------- ----•----•---------------------------•----------------------------------------------•---------------------•---------- -••--- •- --- -- ----- --- ----------- ------------------- - - 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. (Owner and/or Contractor] (Signed)._ _ ----- I ------------------------------- ----- -- ........--------------- By:_------- �------------_-�:r------------------------------------- -------- - -- (Title) ere side]. ""Plat Ian, showing size of lot, location of system in relation to wells, buildings, etc., can be. placed on rev ( P FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_._ --- -----v ..DATE------ ATE-------- �1� -, •; REVIEWEDBY--------------------- ------ ----------------------------------------------:•- ------- ---•--------- DATE_-----------•-- ----------------•----------------- BUILDING PERMIT ISSUED--------------------------- --=------------------•---. DATE Alterations and/or recommendations:-------------------------------- -----------------------•----•----------- ------•--- ------•--•----------------- ---V-.---- •--- ----••--••--------------• ---------------- __._: __::: --- Y� �_- ' _ -- r ---------------- ------------- ---------------------- ------- --- -----------•------------- -----------•------------------•-• ... FINAL INSPECTION BY:_' { Date.----- ✓-----•----- .. --------------------------- SAN JOAQUiN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California E5.9 REVI9E0 e•89 F.P-ro-2M"D