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FOR OFFICE USE; _1 //.'o 0 --------------- ------------------ Permit No. APPLICATION FOR, SANITATION PERMIT k---311�4---------- ------------------------------a----------------- (Complete in Duplicate) Date Issued --- -------------------- ------------------------------------ This Permit Expires I Year From Date Issued Application is hereby made to the San Joaquin Local Heal+h District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No, 549. JOS ADDRESS AND_11�0�_-ATION.Jtv_/�O�----- ---J�Z----------0_15&tra-------------f5/,5 P,!! ------------------------------ Owner's Name------- r1A:Z------- _46�_�_----------------------------------- ---------------- - --------------------------------------.__ Phone----•------------------------------- Address 7 �r l 1�. !r^ ------------- hone----------------------------------- Address---- `� k_ --------------I-----------------------------------------I------------------------------------------------------------------------------- Contractor's Name--- --- ----------------------- ------------------------------------------------------------------ Phone--------------------_------------- Installation will serve: -Residence Apartment House [Commercial E] Trailer Court E] Motel 0 1 ther of� _/ ,F'y Number of liviiig units. Number of bedrooms --- --- Number of baths Lot size -------?--------------------- Water Supply: Public system Commur�ify.system [I Private El Depth to Water Table 4/0-4--ft. Character of soil to a depth of 3 feet: Sand-E]- Gravel E] Sandy Loom E] Clay Loam [] Clay ❑ Adobe Hardpan E] Previous Application Made: (if yes,date------- ............ No EP— New Construction. Yes R3- No E] FHA/VA: Yes P--No [I 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 foundation----1,�9------- --------------- No. of compartmentS.-r--,?----------------Size4X �47_liqu;d depth__.._ ------------capacity_,�&/�------ D:sposal Field: Distance from nearest well.................Distance from foundation----/%:_2__/--:.Distance to nearest lot line---4 ------- Number of knes-----------�L--- - - ----/Length of each line-------?0... --------.Width of trench----r` , .-------------------- Type of filter material.-- Depth of filter material---- .-.Total-length---A� ------------------------ Seepage Pit: F 5istance to nearesf.well-----7r=n----------Distance fi�wn foundation---k7a---------Distance to nearest lot Number of pifs. material---/ /Z------- Depth_.4�_;_�, 4D .!�—----------Lining t941%'K.Size: _,�_�_ _.. Cesspool: Distance from nearest well------------------Distance from foundation--------------------Lininq material---_...__-_-_.._---..__--.--_._--.._- �. ❑ rraferial------------------------------------- El Size; Diameter-----------------------------------.Depth--------------- --=--------------------I--------------Liquid Capacity- - ----------------------_gals. iw Privy: b;stance from nearest well----...._-_-_------._-.-_----------- -----Distance fTm nearest building-_.._-_-_.._________--- ------------ --- 0 Distance— fo'-n e-a-re-�f JoT-line--------------------------------------------------------------- ------------------------------- ---- ------------- Remodeling and/or repairing (describe):. t4 ------------------------------------------------------------------- --------------------------------------------------------------------------------- -- --- - -------------- ----------------------------------------------------------------------------------- ---- ------------------------------------------------------------------------ --------------------- ----------------------------------------------------------------------------------------------------------------------------- 9 ------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------- - ------ -- - 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 rqIes and regulations of the San Joaquin Local Health District. (Sigin"ed)-------------- �,�------ --- --- ----------------------- - ------- --- ----- --- ----- --- -------------------- -- - Contractor) By:-------------------------------------------------------------- -- ------- ------ ---------(Title). ----- --- - ---- --------- (plot plan, showing size of lot, location of system in ;Eon-to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY F APPLICATION ACCEPTED BY------- - --------- -- ------------------------------------ DATE -/-- ----------- - - ----------A-/--------- - REVIEWEDBY--------------------------------------------- ----------- --------------7------------------------------------------- DATE----- ------ ---------------------------------------------- BUILDING PERMIT -- ISSUED------------------------------------- ---- -------------- DATE -- ----------- - % ----------- --------------------%---------- -- ----------- Alterations and/or recommendationS.- ------------- ---------------------------- ------ ------ ----- ------------ - ------------------------------------------ --------------------------------- ------------------------------------------------------------ ------- __---- --- --------------------------------------------------------------------------------------------------------------------------------------- --------------- ----- ------ -------------------------------------------------------------------------------------------------------------------------------------------------------------- ---------------- - ------------ ----------------------------------------------------------------- ----------------- ------------------------------------------------------------------------- --------- ------- ---- -------------------- FINAL INSPECTION BY:.,......... Date--------- ----------- ----------------- .................. ---------------- - SAN JOAQUIN LOCAL HEALTH DISTRICT J0 1601 E.l4axelton Ave. 300 st Oak ttreel 124 Sicam6re Street 205 West 9th street 11-1 Stockton,California Lodi,California Manteca,California Tracy,California F,P.C[3.