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� F�OFFICE USE ---- ------ ;1 ------ ---------- ---------- --------- ---------------- APPLICATIOW FOR SANITATION PERMIT Permit No. -- 1. -. 3 . --------------------------------------- (C0rr'1p)ete in Duplicate) f ----- ------------ -- This Permit Ex ires j Year From Date Issued Date Issued Application is hereby made to the San Joaquin Local Health Disfrict 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 �J Owner's Name-----------f �/----- - �_ - ,L �y - - -� �,�/!�-��d�f--��-��-•-��.�cs{1'ie------------- ----------•------••-- Address----,Ag,__ - Contractor's Name--- -------------------------------------------- ----------------------------------- r_-- _ -� -=- --------------- ---- --------------------------------------- -- - -- ----- -- ------ Phone-----•--• -------------•---------•- Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other 4110 Number of living units: _'�' Number of bedrooms -7-77- Number of baths __l-_ Lot size ��jjf- G� '----------- Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table -(�c:flft. Character of soil to a depth of 3 feet: Sand ❑ Gravel Sandy Loam ❑ Clay Loam ❑ y Cla ❑ ❑ Previous Application Made: (If yes,IdAdobe F] Hardpan ate_____________________) No [�'r-New Construction: Yes e-No ❑ FHA/VA:.Yes ❑. No Lam-~ l j. TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well--------Distan e from foundation----A9-......Mat J - -- -------- ------------------- �- ®� No. of compartments--- ---------- - � � Liquid depth-_ � Ca acit _ P Y t Disposal Field: Distance from nearest well.. ��.--__Distance from foundation_ ��-------.--.Distance to nearest lot lma---_�--_=_-•. ,� 0� Number of lines----- --------------- - - - Length of each line__.P?7------- Width of trench-pt/ - ----_--,- 1n /�j -- Type of fitter material%- -.-.--Depth of filter material--.01-61-------- -Depth len th___ E g -----------------------•----' n Seepage Pit: Distance to nearest well------------- ---------Distance from foundation--------.-----------Distance to nearest lot line._-------.___--_. V , ❑ Number of pits.,--------- -------Lining material------- - -----------Size: Diameter------------------ ---- Depth----------- --------------------- Cesspool: Distance from n larest well-__---_------- Distance from foundation __..Lining material_- ____--____---__--__ El Size: Diameter - Death -_--------------------- Liquid CapacitY----------------------- als. Distance to nearest lot Privy: Distance from nearest well___________________________________- ._Distance from nearest building_--.____--._-----------------Line_____________________ ----------------------- -------------- Remodeling and/or repairing (describe):,_-,C--- -------- .Q�CJ r ----- -al—--- ----- - �( -----• . ,Q ------------------------------------------•----------------- ------------------------------ ---------------------•-----• -----------------------------•-•------ ------------ --- 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 regulations of the San Joaquin Local Health District. (Signed) ---- r Contractor). BY•----------------------------•------------- -----(Title)-- Plot Ian, showing-size { ) �{�"'�-- -------- ---------- ---- By: - - ( p g-size of lot, location of system in rel�ontolls, buildings,.-etc.,.can be placed on reverse side). FOR DEPARTMENT USE ONL APPLICATION ACCEPTED BY- ------------ ---------- -- - ��-� DATE------- - --------------------------------------------------- REVIEWED BY-------------------------------- -- - ----- ----------- -----------------r!-----"------------- - --- ---'-�------c-.•�-------?--�-----4----c-�---�------. ._rDrA�TE- - --�-�-� - - - ---- ---- BUILDING PERMIT ISSUED _ ,DATE ------------------------------ b ----------------------- ----- ------ ' • y c • es -----------------(Alteratons and/orrecom%mendatio s: __ 1 +-------- - l -- - ----- ---- ------------- ----------------------- - - ------ ------ \ ------------= . . ? -.---L_ �F ------ c3 . - '- �- - ------------- ------------ ------------------------------ - FINAL INSPECTION BY:---_.---- ----.- _ { Date---------- --------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haselton Ave, 300 West Qak Street 124 Sycamore Street 205 West 9th Street Stockton,California nodi, California Manteca,California Tracy,California �,�,