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FOR OFFICE USE: ---------------- --- ----------------- ^rte+.--_. ,a �7 l/ -_.-_.-___________________- APPLICATION F 'K SANITATION PERMIT Permit No. ..c _.�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 construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION----- 4 - ;?.------ -_X-Rzl '�--_----------------------- Owner's Name-----/?V_-•(------. fx. �f ----------------------------- --- -. Phone------------------------------------ 'n / �� -Address------------r�---��-.-_T-----------Q �[c .�r�' �rl��v� ''------------4 - ----------------------•------••---•---------------- •--- Contractor's Name----------- - � ffZ�✓ i--------------- ------ ------ ---------------------------- --------•----•--- Phone-----•-•------------------- - Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel [] Other [❑ i Number of living units: ... Number of bedrooms e. r Number of baths . .. Lot size .-` _C�' - -------- ------------ Water Supply: Public system ❑ Community system ❑ Private [��epth to Water Table'It. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe gg,'TTardpan ❑ Previous Application Made: [If yes,date-------------------} No J?" 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 10 Septic Tank: Distance from.nearest wet __. -1d9. .Distance from foundation...P---..-.--Materia f"�.�e ' ..-___.__... No. of com artments..__ - Liquid dep.th--, . ----_-------,Capacity (._. Disposal Field: Distance from nearest well f w f p Distance from foundation-__. 4?_ Distance to nearest lo` line--- ---- .-... Number of lines- _.__.-sr .....f__. __—ength of each line-_ZAP-..:_ _- __ Width of-trench.i2............................ /I Type of filter material. - if epth of filter ma#erial---_ .___._.._Total longth-_Z�_�----..-__._-._.- i 14, _" - � Seepage Pit: Distance to nearest well---//0-..-..Distance from foundation-n.70.------ Distance to nearest lot line./*_.-._.- ' Number of its--3-- F� `� .. pits_! ______._..-Lining matenal..�- 1��..Size: Diameter.-?�__r�..-.....-Depth__.��....... +'��vrf f , Cesspool: ! Distance from nearest well.................Distance from foundation- -------..-....-.Lining material-_.__-_-.------.-..-.---_---------- Size: Diameter-__(--------------------------- -----De th__ �-_-__:..--..........-.------------._.--_____--_Liquid Capacity gals. Privy: Distance from nearest well-------------------------- -----"---------------Distance from nearest building------------------------------------- Ell Distance to nearest lot line.- -- �-----------�-- ��- i- Remodeling and/or repairing (describe=-- -, -- --- ----- ^p ---�----------f -------------------------- T _ �- _...---•--_----•_•............................................l.............................. -•--------•--------- --------------------F--------------------------- ------ _ 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 rules anis regulations of the San Joaquin Local Health District. Si ned ___ ._'� �— ( 9 � t� . 15 J -fes` Contractork By:-------------------------------------------- ----------------------------------- -- Title _ (Plot plan, showing size of lot, location of system in re n to wells, buildings, etc., can be placed on reverse side). k r FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------- ----------- / ------ - ----------------------- DATE-- 4Q�� REVIEWED BY ------ i ---------- DATE------------- ------•--------- BUILDING PERMIT ISSUED--------------- ----------------------------------------------_------------------------------------- DATE Alterations and/or recommendations: -------------------------------------------•-----------•----------•----•------------------------------------------------------,---- I = ------------------------------------------------------------ ----------------------------------------------------------------------- ------------------------------------------__-.:_:.----- --------------------- -------- -------------------------------------------- ----------------------- --- � ' ------------------------------ ---- --- ------------------------------I------------------------------------ ------- - -------------------------- --- ----------- ---------------- - ---------•----------------------------------------------- --•------- --------------------------------------- ----------------------- i �- f�_/ G'------------------x. FINAL INSPECTION BY: •� Date v SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haselton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street ii Stockton,California Lodi,California Manteca,California Tracy,California P.P.co.