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_ -FO- R OFFICE USE: - --------------------------- Q` APPLICATION FOR—SANITATION PERMIT Permit No. .............. ...... l a (Complete in Duplicate) Date issued . - 7-~----� -- ------- 1 t ----------- ---- This Permit Expires 1 Year from Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein descr�e . This applis;atlon is made in compliance with Count Ordinance No. 549. N JOB ADDRESS AND LOCATION Owner's Name------- a Phone Address__..--� 1 �+ ""� 7/-Lr_- rr� xr 1 . Wil."----- --------- - Contractor's Nam e----------- �! �f�� -------------------------- ------------------------------------------•--- Phone----------------------------------- Installation will serve: Residence [Apartment House ❑ Commercial ❑ Trailer Court Mote! ❑ Other ❑ Number of living units: ---/_ Number of bedrooms —3." Number of baths p2--_ Lot size ,, _ T i Water Supply: Public system ❑ Community system ❑ Private R"O'Depth to Water Table _ ��ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam [Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date----------- ) No VT" New Construction: Yes [�lo ❑ FHA/VA: Yes R' No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) /_ ------.Mat Septic Tank: Distance from nearest we��l ._��.'�__._Distance f om foundation_-. ._ �! No. of compartments---- ._-"--------------Size_'�� __- 4 .t Liquid depth_X:----------------CapacityZ2 914-5 ---- �Q s Disposal Field: Distance from nearest well----j�_4_.__.Disfance from foundation .� _ Distance to nearest low line__+a�_ --- �` Number of lines- ----Length of each line_" ----------`� Width of trench.-"------, p ------- Type of filter material/�--O Depth of filter material__.-�il---.- -----Total length----- "-__"""_ _-"____".-"" _.•__`.__...Distance to nearest lot lir�e_��"-f--"- page Pit: Distance to nearest well_-._��,�-_"__Distance fpm fo ndation_ � � Seem' Number of ts.__ _._ Linin material_ -Size: Diamefer� __...f------Depth_s -- -- I!� p �------ g Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material----------- ------------------- ❑ Depth - ------Liquid Capacity----------------------------gals. Size: Diameter------------------------ - Privy: Distance from nearest well---------------------------------------------- -- g------------------- ------------- ' °-`" ---------------- Distance from nearest buil ❑ Distance to nearest lot lire------------. --------------------- - --"-""---""" --------------- \ /f� - Remodeling and/or repairing (describe) Ex-`-- t____ __.____"________________ ------------- __ 4^."`___________________________ --------------------------------------------------------------------------------------_-_-___.___..._ ____________________________ -, 1 _______ --- r I I I hereby certify that 1 haveprepared this application and that the work will,6e done in accordance with an Joaquin County ordinances, State laws, and rules and'regulations of the San Joaquin Local Health District. w, s r Contractor) (Signed) 7(F, l ) �/� ----- - _ - ----- --------- (Plot plan, showing size oftlot,.rlocation� f system in relation to wells, bplldings, etc.,l fan be placed an reverse side). l.� FORrDEPARTMENT USE ONLY ;� 1 APPLICATION ACCEPTED BY ` � - --------- DAT,E--------� I f' I------------- 'DATE------ --------- -- ---- . 4 _______ ___________ . I DATE -- BUILDING PERMIT recomm ndatio`s:.. _._ ------- .0 r d J i _ a - Alterations and/or {. S- -- 0.,....._ -ti I ----------------y-- � ----------------•-- --------------------------- 3 FINAL INSPECTION BY.. ..... . --- ------- bate -,3-_^�.---�-� ------------ ----- ------- -- I SAN JOAQUIN LOCAL HEALTH DISTRICT is 1601 E.Has6lta-n t Avar 300 West Oak Street ` 174 sycamgre Street 205 West,91h Street "� *- Lodi,California Manteca,California Tracy,California stockton,California F.P.CC.