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r R OFFICE USE: . r.. _ -- ------------- ------------ - --- ------ J--f APPLICATION FOR SANITATION PERMIT Permit No. _ . 7z-.p (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 constru t and install the work herein described. This application is made in compliance ounty Ordinance No. 549. ZSZQ 1, f , B JOB ADDRESS., LOC .TI x -------- --- ------------ Owner's Name---- -- -- _aer r --------------- --------------------------------- ----------------- - ------------ ----- Phone----- 745 ------ Address----------- '�.._ 11---- ----------------- ----- Contractor's Name-'----------------- -•----'-:•- ----mow ------------------------.._. Phone----- •---- --------•------- Installation will served .Residence Er-Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel 0 Other ❑ Number of living units: _4 Number of bedroom _._ Number of baths �-Lot size ---e 7T7Xe ---•_-"-------__" Water Supply: Public system ,❑ Community system El Private Depth to Water Tabled�ff. Character of soil to a depth of.3 feet: rSand)Ej Gravel ❑ San oam ❑ Clay Loam ❑ y ❑ Adobe Hardpan ❑ Previous Application Made: (If yes,date......_._.... -------) No' New Construction: Yes No ❑ FHA/VA: Yesto ❑ + TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) I Septic Ta Distance from nearest we11-52-7,---Distance from foundatior,11/Q. No. of'compartments------------- --Size-----a`!-, .�lC?-----Liquid depth_./a—______-Ca acit __ Disposal Id: Distance,from neare well __._-._.Distance from foundation_ p�__---.Distance to nearest lot line_��-"-- Number of lines_____ ------__-- Length of each line__ r ..Jr.Width of trench_-___ -� I/ r - x J1 Type of filer mbterial.-_-//--Depth of filter material___ _- �J ____Total length_. /d s�j Seepage Distance to nearest ell__ 7Distance m foundation... ................Distance to nearest lot fine ____-____-----_ E Number of pits------ Lining material____----Size: Diameter,31?--�".----___Depth_ Cesspool; Distance from nearest well-----------------Distance from foundation------------------_Lining material------------- ❑ Size: Diameter- Depth- -------------------Liquid Capacity—------------------ gals. Privy: Distance from nearest well___---------------------------------------------Distance from nearest building___-_...______._______--- ----------------- s ., Distance to nearest lot line_____.__--_ , Remodeling and/or repairing (describe}: :-"----.__. -------------------•------------------------------i----------------------------------- ------ -------------- ---------------- ------------------ -------------------------------------------------------------------------- - -- ---------------------------------- -----------------lj- e --------------------------------------------- ----------------------- I hereby certify that I hav p epdred-tKisapplication W-fid•that tfie wowk will�be done in accordance;with San Joaquin County ordinances, State laws, a ules and jreg tions of the San Joaquin Local Health District, j 1 (Signed) / -- --- - -- ------- -6[�C ---- •--------------- ----------- - (Owner and/or Contractor) BY:------------------- - i Title ----------------- ( P (Plot plan, showing size o: lot cation of system in relation wells, buildings, etc., can be laced on reverse side). d FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY........ ,. G ` - DATE REVIEWEDBY----------------------------------------------------------------------- ----------------------------------------- -------._ DATE : -- —------------------------------------------------------- BUILDING PERMIT ISSUED------------------------ ---------------- - �. DATE - Alterations a d/or recommendations:..'-------------- -- 1 -Q - _ — - ------------ ---•------ 1 T { -----------------------------------•- ------------------------------------------------------- -----------------•----------------------------------- ------ ------------------------ -- ----------------- ....... ------------- ---------------------------- ---------------------------------- -------------------------------------- ----------------- ----------- ---------------------- ------------ 4 FINAL INSPECTION BY:.----...�'� ------- - - Date------------------------ --- ------------------------------------ f SAN JOAQUIN LOCAL HEALTH DISTRICT 1401 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street - 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy, California F.P.gq,