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OR OFFICE USE: F /r - ---- ------------------- --------- -------------- 2- APPLICATION FOR SANITATION PERMIT Permit No. ................. ... I --y'- ---� ---------- ------�/'-p�---- (Complete in Duplicate) ✓ a Date Issued . This Permit Expires ] Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit +o construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOC ON --- _I - ` i1` ------------------------- ------------------------------------------------- F Owner's Name------------ l.4___ Yt? trri ------------- Phone-- .7 7Y ..S -�y-- Address-------------------- ------------------------------------------------------- Contractor's Name------------ Old--- G.i� -----------•----------------------------------------------------------------------------------------------- Phone..--------------------------------- Installation will serve: Residence ❑ Apartment House ❑ Commercial W Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -------- Number of bedrooms -------- Number of baths -------- Lot size - -X-/ -� `£ �`-)-____.____ Water Supply: Public system ❑ Community system ❑ Private 14 Depth to Water Tablet ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 0 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.) 1 Septic Tank: Distance from nearest well._>Sd_�..---Distance from foundation---1.Q__7_`-------Material--- --------------- No. ___________ __No. of compartments-------c -------------Size------.-------------------------Liquid depth-----Al- .........Capacity----- d Disposal Field: Distance from nearest well------_56--_._Distance from foundation----/_¢1_t-.__ Distance to nearest lot line_____ ,J Number of lines___.____------p---_-____._____Length of each line_________'7S'_1_N�S_-Width of trench.____._ -4-------_------------ Type of filter mate rial_.•__Ce _______Depth of filter material-----/?-------------Total length-------/!0_--------------------------- Seepage Pit: Distance to nearest ------------Distance from foundation_i�Q-,_-?!:__._.Distance to nearest lot lines �----------- 5j sf 5j Number of pits-------I--------------Lining material_ __1 QC ...Size: Diameter-�X-j.....----Depth---e.---------------- ------ --£-esspU0iT- Distance from nearest well-----------------Distance from foundation___-----------------Lining material_----______-.-____.______.____.___ ❑ Size: Diameter-------------------------- - - -- --- Depth-------------------------------------- -----------._Liquid .Capacity----------------------------gals. j Distance from nearest well ...__.-------------------------------------------Distance from nearest bui{ding ; ❑ Distance to nearest lot line- ---------------------- -------- - ----------------------------------------------------------------------------------- --------- _ lJ - _ -------- Remodeling and/or repairing (describe):- _a------ 0=�----- Ot- ---------�--- ------ ------ ---------------------------- -- -- 1 ------------------------------------------------------------------------------------------- ------ ---------------- --- ----- --------------------------------------------------------•------------------------------------------------------------------------------------------ I hereby certify that �haqvterepared this application and that +he work will be done in accordance with San Joaquin County ordinances, State laws, an regulations of the San Joaquin Local Health District. (Signed)___ �'-C--(-_-------.- ---------------- -------------------------------------------------------------------- (Owner and/or Contractor) N Sy:--- ----------------------------------------------------------------------- -----------------------------------------------------(Title)----------------- ----------- ------- ------ ---------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY- -- )------------------------------ -------------------------------------- ----- DATE------- 4 G-----�- ------------------ REVIEWEDBY--------------------------------------------- -- -------------------------------------- DATE-------------------------- ----------------------- ------ BUILDINGPERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE Alterations and/or recommendations:---- �' 'C t ' '7j -------- -•---- 1J i ------------------------------------------------------------------------------- ----------------------------------- -----------•----------------------------------------------- ---------------------------------- -------------------------------------------------------------------------- -- --- ---------------------------------------------------------------------------------------------------------------- ------------------- ----- FINAL INSPECTION BY- �------------------------ Date..------` ------------------ --------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,Colifornia Lodi,California Manteca,California Tracy,California