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FOR OFFICE USE: --- ----------- -.. ' APPLICATION FOR SANITATION PERMIT Permit No. ---. ------------ - --------- - ------- --------------------- (Complete in Duplicate) 7 ra Date Issued ______��,!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 install the work herein described. This application is made in compliance with,/County Ordinance No. 549. JOB ADDRESS AND LOCATION--- 77 --------------------------------------------------------------------- Owner's Name-------_T'-- --------------------------- Phone---------------- --------- Address ------ - Address ''/-----�------------•--------- Contractor's Name--- -- -- ------ Phone VK1---r_ /Sw Installation will serve. Residence [Apartment House ❑ Commercial ❑ Trailer Court 9KIMotel ❑ Other ❑ Number of living units: _-� Number of bedrooms _sx7__ Number of baths cP._ Lot size __./-- - _.-__�__pz_ .o_._-___---_-__ Water Supply: Public system [Community system ❑ Private -•Depth to Water Table .5-0 ft. Character of soil to a depth of 3 feet: Sand ❑ Grave[ ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe [Hardpan ❑ Previous Application Made: IIf yes,clote-----------_--------) No ❑ New Construction: Yes ❑ No R_1_"FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic T Distance from nearest well_/-G ____Distance from foundation__./4-------- Mater al �-------�6/------------------- No. of compartments--- ---------------Size _s7_� r_--Liquid depAh _f__ - ------------CaPauty-l �dd f Disposa field: Distance from nearest we€r,290h.— _.Distance from foundation__-V........Distance to nearest lot line-;_......... t [ Number of lines_______. __ _ __________Length of each line�`_---__,/07V------Width of trench.____.p __Y_-___________-__ �} Type of filter material-- SiSR44-_Depth of filter material___/_g'_`�_.__.Total length______--/-4?Q___________________ N See a rf: Distance to nearest well Distance from fo ndation---,l_4--------Distance to nearest lot line__.------- v [ Number of pits.....9-__._______Lining material-�4J'X_Size: Diameter__. 3.-----------Depth__..r9-_.s'_______________ 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----------.__.________________..____--- ❑ Distance to nearest 1:_/o ne.----------- ----------------------------------------------- --- ---------------------------------------•-•-------------------- Remodeling and/or repairing (descrik� ._. Irl/.L'xrf----Gd-- !___ ---- ------•-- -------------------•------------------------------------ 1t ------------------------------------------------- . • ---------------------- - 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 and egulations of the San Joaquin Local Health District. (Signed)----- --------------------- ---- ----- --- ------------------------------------------------ - -(O ner and/or Contractor) f -- --- �„ --------------------------(Title) �� By: (Plot plan, showing size of lot, location of system in relatioo wells, buildings, etc., can be pla don reverse side). FOR DEPARTMENT USE ONLY i APPLICATION ACCEPTED BY--------- ---------------------E DATE = E/ . _.ti..,�. -— m f REVIEWEDBY--- `_:' '#'b--------- ----------- ------------------------------------------------------------------------- DATE----------------------------- ------------------------------ BUILDING PERMIT ISSUED------------------------ ----------------- DATE---------------------------------------------- -------------- Alterations and/or recommendations:-. ----> --- J_© - ------------------------------------------------ ---------- --------•--------------------------- --------------------------------------------------------------------- ----------------- ------- ---------------------------------------------------------------------------------------------------------------- -----------------------------------------------------------------•-------------------------------- -- --------------------------------------------------------------•-------•--------------------------------------- ---------------------------•------------------------------------------------- ---- ------------------------------------------------------ --------- • ------------------------------------------------------------------ FINAL INSPECTION BY:-------- Ilk 1),,& - Date-_----------. �_ _r "1 .. ----- - ---- -------- S N JOAQUIN LOCAL HEALTH DISTRICT 1401 E.Hazelton Ave. 3 0 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California 'Tracy,California F.P.C C.