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f APPLICATION FQR_SANITATION PERMIT Permit No. ---------- -------------------- - (Complete in Duplicate) --- - This Permit Ex ires ] Year From Date issued Application is hereby-made to the San Joaquin Local Heal}h District fora permit to Date Issued This application is made in compliance with County Ord ante No. 549. P construct and install the work herein described. JOB ADDRESS AN LOCATION{��: 11. �� 3. �,• Owner's Name- " Zf �� Z` G',� - _ ---------- -•-•--------------- ------ .. Phone------ Address . ntractor's Name_ I - .-� �----------- - --- -- � Installation will serve: Residence- � -------•--------�-------- -------------- Phone.__.-------•-------------------- �. �partment'House ❑ -rCommercial ❑ Trailer Court Number of livinguni+s%� - ❑ Motel ❑ Other ❑ Number of bedrooms_ _ Number of baths _f-_. Lot size Water Supply: Public system = 1 .P'--e--- ------------ Y Community s stem Y Y ❑ Private ❑ Depth to Water Table J604{�}• Character of soil to a depth of 3 feet: Sand ❑ Gravel [] Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobej-Cardpan Previous Application Made: (If yes,date.......... .... } No ❑ TYPE OF INSTALLATION:AND SPECIFICATIONS: New Construction: Yeslo E] FHA/VA. Yes [ �o ❑ (No septic tank or cesspool permitted if public sewer is available within 200 feet.) -- . i� Septic Tank: Distance from nearest well___-----Distance from foundation_ � ®� No. of compartments_- Sizei��1j 4 -Mat 'I__�- - -- --------------- Dis Disposal Field: ! ; �� Liquid depth_. Ca a ' y � ------ -'6 --- �' Distance from nearest well-_� - p c,t __ .., __..---Distance from foundation__--- Number of lines_____ f�-----a Distance to nearest got line-t6_-_----•- __ ength ofseach line Type of filter material- � � Width of trench. �� .� -------------------- 414-% D th of filter material t i Total 'length-- Distance -- J--=�t,r Z I Seepage it: Distance:to nearest well_._ r e / -.-_-Distance from foundation__ Number of its--..L �4 5 -- istance to nearest lot li �- -- D P �------ __-_-Lining matenal�; _ 0,� D ,.� I Diameter Cesspool: Distance from nearest well___--_____.- 1 Depth _-bis#ante from foundation--------------- -'Fining material_.--__._--_._- ---------------------- ..Privy. -.- . r ; ❑. Size: Diameter----- -- - -- Depth-------- f- - ------ N '.Privy Distance from nearest well -- -- --- Liquid Capacity----------------- --- -----gals. --- --------- -Distance from nearest building n Distance to nearest lot lin ____ _________ - ..__. ��—. "sem- F -- -- p . ' g and/or-'rape rj ` - ( ;" �. i' s-,`"�---, �-- _ :_ __ _ e odeltn ------ ,- desc�l :� �Y� P !r. -- - ------- ------------------------------------------------ --- ___ _f------------------ --- 1 / ti.y r -------------------------------•---• ----------------------------------------------------------- - -------------- - -,�y: w -- -- --- --------- --- -------------------- -- ------------ - -- i f„ ------------------------------------------------------ hereby certify that I haveprepared this application and that the work will be done in accordance with San Joaquin County . �rantes, State Laws, and rules and��,egulations of the San Joaquin Local Health District. Si ned_ o - - - ------ „� _ �or Contractor) (PI plan,4howin size of lot, location g of syste. relation to wells, buill dings, etc., can be placed on reverse FOR DEPARTMENT USE ONLY �'.A'�j PLICATION ACCEPTED BY . �a �_ REVIEWED BY :' ---------------- -- ----------- DATE........ ------- ------- ---------- BUILDING ------------------------------------------------------------------- PERMIT ISSUED--------------- --�----------- -------- ---------------------------------------- ------ ---------------- ------------------- DATE-------------------------------- ------- ------- ------•------- --- Al+era+ions and/or recommendations:_.. --f/ . DATE------ -- ' ---------- ` n-c �__c.-�cJ LaJ --- ------------- - :.� / / ------------- C'7=—��C r J`' t-- - --- -- ------------------------------------ -------•--------------------------------- --------------- FINAL INSPECTION BY:----- - �r Datl- , 7 r - ---- -- e--------- + i SAN J AQUIN LOCAL HEALTH DISTRICT 1601 E.Huaelton Ave. 300 West Oak Street ] 124 Sycamore Street f Stockton,California Lodi,California ' 205 West 91h Street t M •a. }Manteca,California [ Tracy,California F,P.r-q.