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FOR OFFICE USS: �� l ------ -=-------- --------- ------------ ---------- - Permit No. --. .... . ___ _ -------- --- APPLICATION FOR SANITATION PERMIT -------------- J -------------------------------------- ------------------ (Complete in Duplicate) Date Issued ---- -5---/-- - ----- This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and insFall the work herein described. This application is made in compliiaan e with County Ordinance No. 549. oF JOB ADDRESS AND LOCATIO _�- ------ wew--�--------).!- Owner's Name-------------------��.y�.f�____�.KT—--------------BA-.�?•.K ----R--------------------------•------ ------"--------.- P.hme----------------------------------- Address__ ------- ,Tl __�.. --... _x - �_. 5_:�---------- cR QnI a - Contractor's Name----- -- __ •------ Phone-------------------------------- Installation will serve: Residence E�f Apartment House E] Commercial F] Trailer Court ❑ Motel C] Other ❑ 1 n Number of living units: ._----- Number of bedrooms,_- Number of baths .!-__-- Lot size _" _ • Water Supply: Public..system El Community system ❑ Private ®"Depth to Water Table 3 . ft. 0 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 New Construction: Yes �No ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION.AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest wek-----50....Distance from foundation----I-- -.-.Ma en LC��R�-T�---"------- �:.,--Capacity f 2 e Q---- No. of compartments-------� -------•--Size._-'�_J�-�.-f`�-'-�--Liquid depth----�"---- ---- p Y----- --------- - Disposal Field: Distance from nearest well ---5✓a.---.Distance from foundation------ln-------Distance to nearest lot lint�._5 ... g h f -*� line_ 1*O 4 go Width of trench--------2y------------------ rDistanC!1:`i_fo Number of lines___._____Z_----- -------------Length of each line_/�._.._"---------------- Type off filter material-R�-7--GK....Depth'of"filte*r"maten6P_-. -----Total length............ISO----------------- Seepage Pit: nearest well--------------------.-Distance from foundation--------------------Distance to nearest lot line--.-...._------- 4VUt44. Size. Diameter...... Depth ❑ Number of pits -------------------Lining material p Cesspool: Distance from nearest wefi_ ""'"""'" i"D�stance ftp om fo dation "":Liriinq materiai'�"----- f ------------- ' ❑ Size: Diameter � _R =.Depth- -- `" ----- ----- - Liquid Capacity.. gals. it Privy: Distance from nearest well-------.----- ------------------------------------Distance from nearest building.... ----- ----------------- ❑ Distance to nearest1t line------------------ -------------- ------------- ---------------- ----------•---------------------------- Remodeling and/or repairing{describe}:_.S S.TE+! - 1rq!S, r4i- -l-p-------�R!_DERE- '-�4� K'tN '--'Q 1T`•-- l Rt'rFl f --------- - ------ ----------- = ------- --------------- ----- - -- ------------------------- ------------- I .. F= ------- Is.-"--- -- jtr.lii.iw! -- *�'�. ------a1�n.i�---- a----------art----------•-11----- - --•-------------1--------- --f-------- _ } ------------..... ---- '- ----------- ---------- !r � ------- ----# -------- ----------------------f------•------------ ---------------------- -------:.=" --- - �.I hereby certify that:I have prepared,lthis application and that the work will be done .in accordance with Sari-Joaquin County ordinances,tSta�-laws, nd�ruies_an regU t ns of the San Joaquin-Local Health District .... _ .. Iner-an! or—Contractor-).., (Title)----------------------------- -------------- ----- -------- (Plot plan, showing size of.lot, location of system in relation to wells, buildings, etc., can be placed on reverse sid t)� FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY.---' T.-J _.D-` - ------ DATE------ � '------------------- ---------- REVIEWED BY_. . ,.,. :r", " 'DATE--:.-_-:- �"-"-- -- ---- ------ --- - BUILDING PERMIT ISSUED — --------- -------------- ------ ---- -0ovr4 --- n -- --- DATE------------------ ----------- --------------------- -------------------- --- --- --- osanrrecoendaons: ------------------- Alteratim " - --------------------- ----- FINAL INSPECTIO BY --- -- Date----•--__ --- ---------- -------------------- `-- - � SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street 1 California jLtlanteca,California Tracy,California Stockton,California Lodi,