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FOR OFFICE USE: --------------------------------------------------------- - r APPLICATION FOR SANITATION PERMIT Permit No. .. _ ._I__...__.._ ----- -------------------------------- ------------------ f -------- --------------------------------------- (Complete in Duplicate) Date Issued ._- _ ----------- _---------------------------------___. -- I This Permit Expires 1 Year From Date Issued Application ishereby 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. _. ..-.a 2B� JOB ADDRESS AND LOCATION__:' S� +• 'w -., L,c ----------- - - --------------------- -------------- Owner's Name------ =--------� ----- - Phone----••------•-------------------•--- Address----------------------------------------------------------------------------------------------------------------------------------------------------------------------- --- Contractor`s Name.----- -------C - '----- -7------------------------- Phone---'5 -------- ------ ' t Installation will serve: Residence ® Apartment House E] Commercial E] Trailer Court ❑ Motel El Other E] ' Number of living units: --I---- Number of bedrooms -5-- Number of baths -------- Lot size ------------------------------------------------------ Water Supply: Public system El Community system E] Private Io Depth to Water Table`j.`ft: 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 Jp] New Construction: Yes)� No ❑ FHA/VA: Yes ❑ No K N TYPE OF INSTALLATION AND SPECIFICATIONS: 11 13 (No septic tank or cesspool permitted if public sewer is available within 200 feet.) i Septic Tank: Distance from nearest Distance from foundation ion____.l_O-__.... M t ' ��_ --- -------------- ; a tY (Z0d No. of compartments_..._..7Z _____________size-__4- -xIo_-X5_Liquid depth._.' _ Ca aci - - - - -__-- 1 Disposal Field: Distance from nearest well_-�5--6_....Distance from foundation---1-0----.-----Distance to nearest lot line______ Number of lines----__.__ --_-____-____ Length of each line---_gO'_"'---fu0---.Width of french-_____ - -F�-------------- ®' }} 11------ length Type of filter material6��__C.4_GC�--Depth of filter materiaL___..�.�__ - g 3 See a Pit: Distance to nearest well_._.__rDistance from foundation__-.Distance to nearest lot line -- Number of pits___-.�`�ining material_ Diameter.-�7.Depth_ J--- -------------- e ------------- [� esspo 1: r. Distance from nearest well----------------- from foundation ------------------ Lining material____________________ ❑ , I Size: Diameter------------------------------- ------Depth---------------------------------- -•--- ------.:Liquid Capacity----------------------------gals. 0 It Privy: + Distance from nearest well__..-'__E"__ _____________________________-.-Distance from nearest bui4ding ----------------------------------------- ❑ 1 Distance to nearest lot line -------------------------------------- --------------------------------- ----------- Remodeling,and/or repairing (describe):--------------------- --------=------- ---------------------------------------------------------: ---------- --------------------------------------------- -- ------------------- ------------------------------------------------------------------------------------------ _. --------------------------------------------------- F� V! ---------------- '-------------- --------- I hereby certify the+ I have prepared this appIicAonsand that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations--of the San Joaquin local Health District. ---------------._.(Owner and/or Contractor( > t Si ned { g ----------------- ------ - Tom.,.. >; ! (Title)----------------- ---- - (Plot pla , s wing size of lot, location of system in relation to wells, buildings, etc.,, can be placed on reverse side). I FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY��'-0. ------------- --- -- ----- -----------=----------- ------ DATE--- �---fir-- ----------------- _ REVIEWED'BY---------------------------------------------------------------- --`--- -- ------- --------- ------------- - - ©ATE BUILDING'PERMIT ISSUED-------------------------------------------- ----------------------------------------------------- DATE-`--- ------------------------------------------------------ Alterations'and/or recommendations:.�/� ................ = --------- ------------------------ - -- ------------------------------------- f _ /«2' �tc.�oC�� -- � ccc ei 7 4 _ ----------- a - ------------------------------ - -------- - f� r t -- --------------------- ------------------ - ------ --------------------------------- f' -------------'- --------------------- -- ---- --- ----------- ' -----------------------------------------------/ - FINAL iNSPECTION—BY._-_ ...._.._ Date SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Ho:elton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California r F.P.CO. _ -