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FOR OFFICE USE: ----- --------------- -----------LR__/- i-_..---_--.- APPLICATION FOR SANITATION PERMIT Permit No. --------------------------------- ------------------- (Complete in Duplicate) --- --------------- - ------ This Permit Expires i 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. I JOB ADDRESS AND LOCATION_ •S -_ -.---------- !1_V_C_Z_A 1Z--/---/--1/,'p-- _S-/o e(C7�o�1- Owner's Name +�- `...LAR.4. L!" �1q _r J 4��Phone & .1.. - Address -----------•----- / r i� p leo Contractor's Name. i -----------L y-- C --------------- Phone ±%.l-!l/ _! Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ® Orf-/Ce- Number of living units: -- Number of bedrooms ------- Number of baths -------- Lot size --------------------- 'Water .-----_'Water Supply: Public system ❑ Community system ❑ Private 0 Depth to Water Table �r ft. Character of soil to a depth of 3 feet: Sand E❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay [❑ Adobe X Hardpan ❑ Previous Application Made: (If yes,date---------_----------) No ❑ New Construction: Yes ❑ No ❑ FHA/VA; Yes F1 No ❑ 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--- d -rDistance from foundation-- ------ -------- _ �� Material_... _ ._-. No. of compartments_--�i----------------Size- -- _ f 5C S--_ Liquid depth---4`7.�,_ --------Capaci#y _ Q Disposal Field: Distance from nearest well._, _0.0---Distance from foundation ----- /-------------Distance to nearest lot line----------------- Number of lines-__ - - -- -/�_---__Length of each line_-.__f�1-------rrr Width of french____ _r�,_.----__----. k Type of filter materia!__ EJB--'_-_Depth of filter material_. _Q_. Total length---.___T O-----_------ - ------------ i Q Seepage Pit: Distance to nearest well___. -_---_Distance rom f ndation__ a--------pistance to nearest lot line-- Number Number of pits--- +(f _Lining material_-! _.Size: Diameter.-3 11-_ - ' Dep#h__ . Cesspool: Distance from nearest weft-----------------Distance from foundation----------------- _.Lining material----._------_--.----.-__ _ ❑ T Size: Diameter---- --------------------:-----------Depth-------------------- -------- --------------Liquid Capacity -- 9als. Privy Distance from nearest well------------------------ _-_-______._Distance from nearest building �. Distance to nearest lot line_________________ Remodelipg and/o repa'ring,�1 escrib ) ------------�•-`---LI- iN i-_--S------- ---------------- ---- ------------- ------------ ------ - - ----- --- _-__76 ------ ---- ----- ----------- -� ------------- ------- ---- - - - ---- -- -- ------ ----- -------------I---- S-� Q L--------------------------- --------- --- ----------- --------- --- ---- I hereby certify That I have prepared this application and that th work will be done in ccordance with San Joaquin County ordinances, State laws, a les and regulations of the San Joaquin Local Health District. (Signed) - _1C-l.s- -0-/V_ (Owner and/or Contractor) r By - � ---- ----- Title) -- - -----eaf�ion -------------- -- o plan, showing size of lot, location of system in re to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--- VA G- PATE---___-_y 6 -- ------- ------ ------------------------- EVIEWEDBY ..----------------------------------------------------------------------------- DATE ) BUILDING PERMIT ISSUED--------------------- -- �Alterations and/or recommendations.-- TE------ -- - ---------- ------- -------- ------------------- - _ -------------------------------------------------------------- ----------------------- ---------------------------------------- - -------------------------------- -------------------- ---------- ---------------- ------------- ------------------------------ ----------------------- ------------------------------------------- ----------------------------------- FINAL INSPECTION BY:. --- `------------ Date------ SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.p,CO.