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-------- �' �- - ____ APPLICATION T-QR SANITATION PERMIT Permit No. ___/71�__ y- ------- ---------- ---------------------- ------------- (Complete in Duplicate) --- - ------------------ -------------- ------------.--- This Permit Expires 1 Year From Date Issued 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 compliance wiiit/th County Ordinance No. 549. ` JOB ADDRESS AND O ATION_._ �W----�- � -� 1--p .-------- SIJ�r- --------------------------------------------------------- Owner's Name------- = �------ 1�rr__ _ Phone ---•------------------------------- - - ------------------ = ~ Address....--------------- Contractor's Name -r --�'. -----.-------- ------•----------- ------------ Phone----------------------------------- Installation will serve: Residence ❑ Apartment House /Commercial Lrd` ❑ Trailer Court ❑ Motel ❑ Other Number of living units: _?Z_ Number of bedrooms _- _ Number of baths --- Lot size _- 2ez%✓ '3 � '� '7 26 - _4•'-�[.-�Z�---•--------------•- �--.. Water Supply: Public system Community system ❑ Private 0 Depth to Water Table _4 ft Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Kj�-_H ardpan ❑ Previous Application Made: (If yes,date-----------------__I No �' [/�`"" New Construction: Yes-�[�No ❑ FHA/VA: Yes ,r[�-- No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) i Septic Tank: Distance from nearest well_--__-- —..--Distance from fo ndatioon__:.X-l�__ __ - _ - .Material__�_�. [� No. of compartments---a _-_.__-----__---Size �/I .�1 �Liquid``depth------ f------------CaPacityz67 .---• Disposal Field: Distance from nearest ell_---"`__. Distance from foundat�n---1Je - Distance to nearest lot line_., °' ----•- �� Number of fines-------- -- -- ----- Length of each fine---_,l�_�----_�---.Width of trench__----Type of filter material__ _ Yp ` 1Depth of filter material-- ------ '.Total length__ Seepage Pit: Distance to nearest yell_._--_:_ -------Distance from foundation___x rte _�_ Distance to nearest lot line__�.�,__� ----- Number of pits------P.�-----------_Lining material__- Size. Diameter_��'�f�-----_--Depth_�;.`l_T�'�� e Cesspool: Distance from nearest well_________________Distance from foundation--------_____-__:YLining material-------------- _____--_._____ _.__. Ej - Size: IJiameter -Depth ------------- - --------------Liquid Capaclffy__ _gals. d" Privy: Distance from nearest well-----------------___------------------- from nearest building. ❑ Distance to nearest lot line----------- --------------- -------------- X - ------------------ ------------- - 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 rule and regulations of the San Joaquin Local Health District. 3 (Signed}- ----- - J' �� f�/G } rtd/Gor Contractor) �y: - '(Plot plan, showing size of lot, location of sysfe relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------lam. r _..---------------------------- DATE.- � �`� � (REVIEWED BY ---- - - / - ------------ --------------------------------------------- DATE -- ----------------------------------- UILDING PERMIT ISSUED ------------- DATE Alterations and/or recommendations:_-__-____ /- y - s _ j--_ -- �� _ ----�—_ �------ ----------- --- ---------- . - // ------------------------------------------------------------------------------------------------------------ ----------------- ---------- FINAL INSPECTION BY__ _• -----SANO�--"---�--------------------- ADate........ -----q/ --e-- LOCA -, DISTRICT 1601 E.Hazelton Ave. '30o West'oak Street ; �1.2q Sycamore street }. - 205 West 9Th Street Stockton,California Lodi,California Manteca`,Califorriia Tracy,California F.Rl