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FOR OFFICE USE: 77 ,�- --------------/0 ------ --......"---------------- ------------------------- APPLICATION FOR SANITATION PERMIT Permit No. .r�...11,915-11 ------------ - ------------------------------------------ - {Complete in Duplicate) ---- - T -This'Permit Expires 1 Year From Date Issued - Date Issued Application is hereby made to the San Joaquin'.Local ealfh District for a permit to construct andr install'the work herein described. This application is made in complianc 7f nt rd' an -No:-549.— JOB No-549.JOB ADDRESS AND LOCAL OIX �lV rT_ L`--"- --------- Owner's .Owner s Name---•------ 0 Phone �',�J f �".. Address---------==-------------•------- -- --- �/ - ---- U�'`... ---- --1�----------��r ---------• - - - Contrc �'s Name - ------ - -- ---------- ----- � ll -- Phone ff-- - -��1.7 1DbT . Installation will serve: Residence K Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel.❑ Other El Number of living units: --V Number of bedrooms _4-" Number of baths -.3... Lot size Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table 1-Q. ft. ". Character of soil to a depth'of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe X Hardpan Previous Application Made: (If yes'date___.._ } No New Construction: Yes No ❑ FNA/VA: E]Yes No r n 4 y tTYPE OF INSTALLATION AND SPECIFICATIONS• w (No septic tank or cesspool permitted if public sewer is.available.within 200 feet.) Septic Tank: Distance from nearest well--- Dista ce from foundation—_.&Iterial._ No. of a com artmen}`sY .. - -- -. - _, . _- - -- Capacity-- Disposal a aut DisPosaI Field: Distance from n eare�t well._.. ...-___Distance from foundati �y_�.............Distance to nearest lot line.-.___-" .....:'. Number of lines__... __..- Ir _-----____Length of each lines ,v r Width of trench--.:,P- I _ 4, rr �7 kf Type of filter material-.f_ _- (_KDepth of filter rriaferial...__ _ .-__--- "Total length.__ k --------------------Distance to nearest lot-line.._--_-" �� Seepage Pit: Distance to nearest we!l......................Distance from foundation._......-._.. ❑i Number of pits- . ---------Lining material._•. E„------.....-. '.Size Diameter..... . ..... .. .....Depth -----.-- ----------------- Distance --------..---.. 0 Cesspool y. Distance from nearest well-----------.-----Distance from foundation--------------------Lining material.._.__."....................t ❑ Size: Diameter-- -------------° --------------Depth------ -------- -_ ) J 4 --------------------Liquid Capacity... ------------- -------gals. Privy: I Distance from nearest well-------------------------------------------------Distance from nearest building-------------------------------------_- ❑ Distance to nearest lot line -- --------------------- '- --- and/or repairing (describe) � I -------------------------- Remodeling •----------•- ° t -' -- --------------� ---------- -• ---- ------ t # ; -;-- -------=; ----------------- = ------------ --- - - -- _ w _ . ! hereby certify that I:hav repared this applicatior►`and'that tl,e wor if[ be done in accordance with San Joaquin County t` ordinances, State laws, and es andy regulations the San Joaquin Loc ealth District. Signed)------------------------- -- --- ---- i ., - (Owner and/or Contractor Plot Ian, showin--size of lot" I"""""tion of system inreltion to wells..buildings," c..""" "{Title).".E' o-\ --.-.__---"-".:--._"--"-"-__-__-___-B - ( P g y etc., can be planreverse side). FOR DEPARTMENT USE ONLY 1 r APPLICATION ACCEPTED BY... -...----- -- ---------- ------------------------------------------- DATE �1 ��REVIEWEDBYBY ----------------------------------------------------------- ----------------------------------------- DATE ------------------- BUILDING PERMIT ISSUED------------- --------------------------------------------------------------------------------------- DATE Alterations and/or recommendations:.,------------------------ -----" -------------------------------------------"-------------------------------------------------•--------------- i } -----------------------------"-------------------I----------------•------------------------------------ --------------------------------- --------•------------ FINAL-'INSPECTION BY:" ----- - -"""" j�o�' i'� •^- Date --- - ------- -- --- ------------��-------- ~'.----------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 01 1601 E.Haxellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy, California , F.P.CO. y