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FOR OFFICE USE: ---------- ---------- APPLICATION FOR SANITATION PERMIT Permit No. .-f,7J22.L. - ------------------------- '----------------- (Complete in Duplica+e)- Date Issued -.- ---------------------------------------------------- This Permit Expires 1 Year From Date Issued /l`•"�'" " Application is hereby made to the San Joaquin Local Healfh 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 ANDLO ATION--JY/Q--- :a..: 7 � �'--------0-15 17------------- ------------------------- Owner's Name-------4�;_- /Z- --- -- ------------------------ Phone-----•----------------------- Address.......... // �p� �. fes'^/� -Je .. ------ - Contractor's Name.-- ----A - --- Phone..... ............ Installation will serve:-Residence ❑ Apartment House Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ � Number of living units: -_9q-- Number of bedrooms .-- --- Number of baths --c._ Lot size --- . .. Q_ ..-.-__-_-2_�X 7._G- Water Supply: Public system [Community system El Private F] Depth to Water Table 114-ft. Character of soil to a depth of 3 feet: Sand-❑-. Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 2Y Hardpan 0 Previous Application Made: (If yes,date- No Epi New Construction: Yes P3—No ❑ FHA/VA: Yes R?'No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool-permitted if public seweris available within 200 feet.) Sepfic Tank: Distance from nearest well------ - Distance/`from foundation----1Q.--.---Material--- __ __ �'� -------------_---. ❑� No. of compartments..... ................Size--'FX + 464/2-Liquid depth.....!� ......-_.._---Capacity./f;?,(--,�------ disposal Field: Distance from nearest well.................Distance from foundation._-A-9-1----.Distance to nearest lot line.... Number of lines.-.-_--__ -... E ❑��' .--�-- - /Length---- Length of each line----- - --t�- - - --- - Width of tBench----rs,�..,----.------------------•-- Type of filter mafieriaL.-, 2C Depth of filter material.... ��"---.-Total IengtEl.-- 0 __�___---.-__-------- /' / Z—i Seepage Pit: Distance to nearest we€1....-_--r_�-.-.-_---Distance fr�' fouhdation 44a—_---__.Distance to nearest lot_)fe--- ----------- �' Number of pits-_...,�........._Lining material---1,_f-c?96 Size: Diarreter._2,,�... /-_...---Depth. Cesspool: Distance from nearest well'----------------Distance from foundation_-._.-_- ------ Lining, material...-.....-----------.---------_---.-.El Size: Diameter-----------------`------------------De th---------.-.--. '•I-- - ---------Liquid Capacity gals, Privy: bistance from nearest well-------------------------------------------------Distance`fTrn nearest building---.--.------------------------------.- -_ x — -- - - _ ❑ Distance to nearest lot line-- ---------------------=------- --- ----------------------------------------------------------- Remodeling --._.------- fe Remodeling and/or repairing (describe): � 'l�f 6? '. .---------•---------- ---- ------------ --------------------------------------=-------------------------------------------------------------------------------- -- ;1- ------------------------------------------------------------------------------- ------ (� - ---------------------------------------------•---------------------------.---------------------------------------------------------------------------------------------------------------------------------- -- �j ---------------- ---------------- -------------------------------------"-------- '--------------------------------------------------------------------------------------------------- sr I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin Counfy ordinances, State laws, and r les and regulatio s of the San Joaquin Local Health District. 3 (Sibned)-------------------- -L- - ✓--- -/-------- ------------------------------I� or Contractor) By: -------------------------- -- l (Title �1 (Plot plan, showing size of lot, location of system in re on to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY. ------------------------------------- DATE - ---"f_" K! -- ------ ---- - -----------------------------_r---------------- REVIEWED BY-------------------- DATE BUILDING PERMIT ISSUED------------------------------- ---------- ------------ DATE-------------------------------- ------------------------ Alterations and/or recommenlaionV.. _ --------------------------- ------------- rL--___-- "Y ------------- --- ----- ------------------------------------------------------------------------------------------------ ------------------------------------------------- -•----------------------------------------------------------------------------------------------------------------- ---------------------------------------------------- - - --------------------------------- ------------------------------------ ------ -------------------------------------------------------------------------------------------------------------------------------------- ----- FINAL INSPECTION BY:.. �. Date --------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haselton Ave. 300 St Oak StrAet, 124'Sycamore Street 205 West 9th Street Stockton,California Lodi, California Manteca,California Tracy,California F.P.C C.