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FOR OFFICE USE: — - - ^ n w -------- ---- APPLICATION FOR SANITATION PERMIT Permit No. _.4&3_1.._.__ -- ------------- i1-- --- --- --------- (Complete in Duplicate) This Permit Ez ires 1 Year From Date Issued Date Issued /Z14y_. Application is hereby made to the San Joaquin Local Heal+h District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. ip '7 Z 0 JOB ADDRESS AND LOCATION.___*_tXZ9-- -------•-------- f� Owner's Name------C 1 (X-I?" _. ..= Phone------------------------------------------------- r� ----------•-•-1-:!tt.. ---7_4___ ------ -- Contractor's Name------ .�.1`___ _ `w t- ---•- --.... Phone.. Installation will serve:ZResidence K Apartment House Ej Commercial ❑ Trailer Court ❑ Motel Numbelf ❑ Other � of living units: _Z.- Number of bedrooms - --- Number of baths _Z•-_ Lot size _,_S&___K..___14 r ------------------------- - Water Supply!: Public system XL Community system E] Private E] Depth to Water Table fps ft. Character of sh Mit to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam E] Clay ❑ Adobe JL Hardpan ❑ Previous Application Made: [If yes,date..._�a$_ -_._) No [INew Construction: Yes ❑ No [K FNA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: '- Distance from nearest well-----------------Distance from foundation_.---- � ' _ ------- ---.. Material----- �------------ ----------- ---------- --- !(tiS}'1 n No. of compartments----------------------`�Size ' -. Liquid depth ------ -----------Capacity----- Disposal Field: Distance from nearest well___V1C*LL__Distance from foundation to nearest lot line`--�1 f►1 �.l(is ► Number of fines--------I--------- f---- ---Length of each line_4-----��1-----------.Width of trench. -- N �a � - Type of filter'materiaL�..� ,-_Depth of filter material_---.1.&a'--_-_.Total length..._..._.�- Seepage Pit: Distance to nearest well------- --------------Distance from foundation---..--------------.Distance to nearest lot line-------_.----- ._ ! a ✓` Number of pits.- ,Lining material Size: Diameter Depth -------------------- Cesspool: Distance from nearest well--�___ ____pistance from foundation._____-------------- material--------------________---- W --------- N ❑ 'Size: Diameter---=- - ------------- ------ ------- Depth-------- -------------------- ' ----Liquid Capacity---------------- ----------- Privy: Distance from nearest welt___ I .gals. _ --------------------------Distance from nearest building-------------------------------- _ ❑ �, Distance to nearest lot line-----_____________._ - ------- ----------- ------------ Remodeling an /or repairing (describe):___.-. -.-_-_ {� M -------------------------------------------------------- --•---------------------------------------- __.----__ ___ 1 kk ___._I_________________________________________ ._____.------------____ --__..._,_________.-__-__.____._ ______. _____________________________________________________________________________________________________________________________ _ ------------- ------------------.r _.:,. r ..r - ------------------------- -=----------- -------- ------------------------------ -- ------------------------------------------------------- ---------------- --------- I herebycertify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed)----------?-��:' -,-h -[---------- ----------------------------,-=--- -------------------------------------- By. I _ -------------------------------------(Owner and/or C ontractor) --------------------- •---------------------------------------------------------------------------------------------------- ------ 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 ff APPLICATION 1ACCEPTED BY--- _- __--------------------'----------------------------=----------- DATE---- LI ' --------------------------- REVIEWED BY_,I---------------- ----------------- ------- �--'------=---:--------------- ------------_-- _--------------------------- DATE , BUILDING PERMIT ISSUED --------- ----- DA-TE Alterations and/-- recommendations: ---------------------------------------------•-- -------------•--------------------- ----------- --------------------------=--------------------------------- - ------------------------------- -- --------------•-- ------------------------------ i ------- FINAL INSPECTION BY:----_ - G - -- - _ J/ � G� ------ --- ----------- Date.. f E/ ------ rSAN LOCAL HEALTH DISTRICT 1601 E.lla:elton Ave. 300 West Oak Street 124 Sycamore Street I 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California