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FOR OFFICE USE: _____________ __ �,_-,-----., APPLICATION FOR SANITATION PERMIT Permit No. �..... � - -. ¢ - (Complete in Duplicate) --------------------------------- This Pert-it 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 O.CATIONJ-------�Q_;IV--,/ G�( L1�----------- ----------- -------------------- -------------------------/-----��`------------�------ l� Owner's Name � "Cj�Gf.. 9C.>-�" - Phone 7�s.,�7-�+r ` { Address........-...........-----•-------------- ----------------- ------•------------••--•-------•--•--•----------------- -- ---------------------------•--•------•----- Contractor's Name---- 0CG'd7�. -------------------------- ----- ------- ------------------------------------ •- Phone----------------------------------- Installation will serve: Residence Apartment House ❑ Commercial E] Trailer Court E] M�offeyl E] Other Number of living units: __ _ ._ Number of bedrooNumber of baths-----J Lot size Water Supply: Public system �3eet- Community system ❑ Private ❑ Depth to Water Table _4 ft t Character of soil to a depth of Sand Gravel` San Loam Cla Loam Adobe and anP ❑ ❑ ❑ Y �No Y ❑ � P ❑ Previous Application Made: (If yes,date---- -_--_----- ) No New Construction: Yes ❑ FHA/VA: Yes ❑ No Ea�-� TYPE OF INSTALLATION AND SPECIFICATIONS: �~ (No septic tank or cesspool permitted if public sewer is available within 200 feet.) J SepticT Distance from nearest well, _U -._Distance from fou ation_.-_/Q__._._;._,Material ___. r'�lf ______-- EV P --Liquid depth---- -- ------- Capacity--- No. of compartments -_ _- Size__�X_�k.8_ i JAV4_ .r_Distance from foundatign�_- Dis oral d: Distance from nearest well- - _ $' _ 1�__'�_.Distance to nearest lot line___�l___ ______ p Number of lines _____________ ___``.____ _____ ength of each line-- __'J�4�Width of trench_-_-_='-_-.______.__- Type of filter materiak- . T!C- Depth of filter material /it ---_Total len th___ YP - P g Seepage Distance to nearest wail_.--AIC .--Distance om cundation__ — _t__..D•stance o nearest lot line_ S. Number of pits._----/-.-.-._-__Lining material__ AC ___. Size: Diameter__e�6 _Depth-----�_.�___________ 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 lot line .. line ----------------------f--- - - -- ----- ---------------------- ------->---�--------------•---------------- --f----------------------------------------4-------- - -•- " ---4L_4Remodeling and/or repairing (describe):- nee /4'e- lhQ_._ 4 ^ s7 � ----------- - - r. X._tmlK ------ ¢>`rr ea 4 G�[",f! �/lam � r��'hG - ----------------------------------- I reby certify that 1 have prepared tf'iis application and that the work will b6ne e din accordanc&,s th San Joaquin County ordinances, State laws, and rules a d regulations of the San Joaquin Local Health District. (Signed)-- -•-- - ------------ ----------- --------- ----------- ---=--------(Owner and/or Contractor) BY:---------------•---•-•--•-----L----------------------------------------- -------------- --------=---- -------------------------(Title)----------------- ------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed;on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----..-.- DATE-- -------------------------------------------------------- ------------- -- ------------ REVIEWED BY ----- ----------- ------------------------- DATE------- ----------- BUILDINGPERMIT ISSUED-------- -- ------------------------------------------------•---------------------------------------- DATE--------------------------------- --------- ----------- Alterations and/or rec melndatti ns:--- --- "`� 7 ' - - ---- --------------------------- ----- -----------L---•--------------- --------------------- " �� - . . - - --- _-- - -- - ---- ------------------------------------- -------------------------- ---- ---- --- ---- - ----- k ♦v-da--7/ /- L'abe FINAL INSPECTION BY: - Date............. ----------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1. 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th gpet Stockton,California Lodi, California Manteca,California Tracy,California E.H.9 2M 1.67 Vanguard Press 1"