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� .F =OFFICE USE: _ ----------------- / Permit No. -------0...�a-J ----- ----- --------------------------------------------- APPLICATION FOR SANITATION PERMIT �. -------------- ----- - (Complete in Duplicate) Date Issued --- - This Permit Expires 1 Year From Date Issued ibd. ---------------------- — Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein descre This application is made in compliance with County Ordinance No. 549. cC -------- JOB ADDRESS AND LOCATION-------9 !N-r----.... -- ------- --�---------------------------- - noe _ki`rS--------- ---- - --------------------- ---------- Phone—.7------------------- Address -PS3f Owner's Name__..�-�i.- -------- -- -- ----------------- ----- ------------- - -- Address-----------A/A-8p � -----------------••-------------------------------•------ -- LA Phone- _. Contractor's Name----------- 1-A _ - f Installation will serve: Residence R;J- Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _-t_-_ Number of bedrooms ---2-- Number of baths -�(---_ Lot size ----- �Z,S ------------------------- Water Supply: Public system 'Community system ❑ Private F1Depth to Water Table Gj-i ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 23-�Hardpan ❑ r Previous Application Made: {1f yes,date--------------------) No [!]" New Construction: Yes ❑ No [4- FHA/VA: Yes ❑ No [?I— TYPE OF INSTALLATION AND SPECIFICATIONS: ° (No septic tank or cesspool permitted if public sewer is available within 200 feet.) � No. of compartments ------------------Size------------- •- - ation---------------- ..Material------------------------------------------------ No. ----------- ---------------------- } Septic Tank: distance from nearest well_________________Distance from found- Liquid depth--__._.__...__-__-_______Capacity..-___..-_-_____--_.__. ' p - Disposal Field: Distance from nearest well__lyb_-___-__Distance from foundation---�f�.__-_..__Distance to nearest lot line_�___._-._____ � Number of lines---------Z--------------- - Length of each line------J-Pi . .. ------.Width of trench---------Z--------------------- �. Type of filter material.-----1 .0-�L---Depth of filter material___f- --.-.__-._Total length-------- _U------------------ ------ �,• S Seepage Pit: Distance to nearest well-_M -----------Distance from foundation__/�____._._--.Dista nce to nearest lot line_..._-_..-____ N �. ,7 .- -- -----Depth-------Z3 ---------------- s Number of pits_----- -- -----Lining material.___ ° ._<_-5ize: Diameter___ Cesspool: Distance from nearest wel4-------- ------Distance from foundation.--____---_._----_.Lining material--._-.___-.___--_.______-_-_--___- , n ize: Diameter--------------------------- - ---------Depth----------------------------------------- ----------Liquid Capacity-.--------------------------gals. V ' S Privy: tante from nearest well----_------------------------- - Distance from nearest build''rng._..______.__-__:-------------------- .�� ❑ I Distance st lot line----- ----------------------------------- ---- ---------------------------- -------------- --------------- Remodeling and/or repairing (describe):----------------------- --- ---------- ------------------------------- --- ---------•-------------------•-----------------------------------• . ----------------------•--------------------------- ------------------ ------------------------------------- -4. ------------ ____________________________________________________________________ P PP---------------------------------------- ------------------------------------``Y----.:z�:_ ----------------------------- P are -- I hereby certify that I have prepared this application and that the work-will'be done in accordance with San Joaquin County I ordinances, State laws, and rules and regulations ofthe n Joaquin Local Health"District. 100 6 ._-_---(Owner and/or Contractor) (Signed) - Ile)--------- ----- --------- ----------- ------- ----------- By: (Ti+ an buildings, etc., can be placed on reverse side). (Plot plan, showing size of lot, location of system in relation to wells, FOR DEPARTMENT USE ONLY --�- - --------------------- --------- DATE- --�"---'--f-�--'--��---------- ------- APPLICATION ACCEPTED BY- _... - -- �---------------------- ------. DATE__..-- _ _------------------------------------------- F DATE------------- p _ -------� BUILDING PERMIT ISSUED.---------------------------- --- - Alterations and/or recommendations:---' -'-Z-12.l._ s---------- ---------l.Iq 1:------•----- �� -^ - -----------•--- -----------------•------------- C t ------------------------------- ------------------------ ---------- ----------------- --------------------------------- ------- --------------------------- ------- ------- ------ ---- FINAL iNSP1=C 'r T10N BY:------ - ' '-------------------- ----------- Date--- �. SAN JOAQUIN LOCAL HEALTH DISTRICT ti 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street y Lodi,California Manteca,California Tracy,California Stockton,California F.P 0.