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FOR Off ICV USE: ' n.x. . � 7�. .s .G� ._.-.... _ APPLICATIONFOR SANITATION PERMIT Permit No. ...�?�...r Z.. 4�c{_LC:__�C a�(�'c_� ...---:� _ ' (Complete in Duplicate) ...-J-- .. ........... -�-�--�- - - �--� � ---.- -.� This Permit Expires 1 Year From Date Issued Date Issued ----- Application is hereby made to the Sen Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County OrclinanjSg No. 549. JOB,ADDRESS LOC TI N....._.-•----- ._. a. ......... ��..� . . ...._.. Owners Name.... . d .l��.1".1__►'Yt�'.S Phone ..-7-/✓{ _.. - ----------- .... Address Contractors Name__... ...... .w_]1fl..................•---. --''-':.::-.---•--.......... ............... ---....----•-.. Phone.---::- ••-----------• Installation will serve: Residence ❑ Apartment House ❑ Commercial TrailerCour} -] �M�� ❑ Qtfle�(-14 Number of living units: ........ Number of bedrooms ........ Number of ba<s ........ IlLot Size ........... Water Supply: Public's stem 90 y ❑ Community system ❑ Private Depth to Water Table d.11 ft. + Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ AdobeX Hardpan ❑� Previous Application Made: (If yes,dote__._ .......) No ❑ New Construction: Yes No ❑ FHA/VA: Yes ❑ No [] TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank'or cesspool permitted if publicf sewer is available within 200 feet.) / Se tic Tank: Distance from nearest well 46_.0.....- ..Distance from fqundation----/Q--------Mater; I....... i.:_ No. of compartments--.- Size.___ Ca oci �/ f...Liquid dap+h...-•L- P ty__-70 it Disposal Field: Distance from nearest we ... F'...... f_Distance from foundation. . A , t P . . . ��!.. Distance to nearest lot Ilne.-�......... Number of lines............. .............. Length of each line...._...�r Width of trench._.. ............. Type of filter material----J*�e �-�-!-Depth of filter material---..._/T....,....Total length-_._..._-.. Se page Pit: Distance to nearest well... ..Q_.... .. .,.-Distance from fpqndation.._. ......D* tanchto nearest lq line. ............... s '.. ( .!..Size: Diameter..--_-;?. .........Depth.-- r�1�.�......... Number of pits.......✓✓..... .......Lining mate ria Cesspool: Distance from-nearest-well.-•_—.-.-..-..Distance-fram-fouridati0n-... ............L•ining material-'_-.`../..?'_._....._...-:._...._. ❑ Size: Diameter-------------- Depth............... .. .................................Liquid Capacity. --•---...................- gals. Privy. Distance from nearest well..:...:...:.....'. .' c.*...............Distance from nearest building.......................................... ❑ Distance to nearest lot tine._`................ ..:...... = l ----,_.--.-c---------- ---------------•---`---------------•--------- Remodeling and/or repairing (doscribe):. ......... ......... ................................................................-...... .............................._...-----••-------..... ....-------••---•-------•--...------••--••-----•--•---...........---------------•----•--------- ...................................... ....................................................................................I _• ... ............ ......... . -------------------------............................)-...........................................I—,. :....... ............... I hereby certify that I have prepared this application and that the-work witl be done in accordance with San Joaquin County ordinance State law , n les regulations of the San Joaquin Local Health District. (Signed}..... .... . . v._ - -._::.-------------------------------- .. (Owner end/or Contractor) By:---------------------!............................................. ....Title (Plot pian, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). j FOR DEPARTMENT USE O Y APPLICATION ACCEPTED BY..................... . ............... . .. . ......W ... .-- ---- --_....--- DATE.------ " - ................. REVIEWEDBY-----------•- ----...... ......----------.....--•................ ...............-----------•--•-----...................... DATE----................------------- BUILDING PERMIT ISSUED---------------------------------------------••-----•-------- /4�jC- Alterations pnd/or recommenndations:.....�r%��t .__�� -�/t c T,� �•.... 01<f -".�.. ....... Z------ .......... �� _! -t? `�......�G`�o°�.. 7 Lac!-x-C:.p. �-..'Y..-i _... ._<....-•---1 '•----F� `-^t•`"v)'��-C�c_�r,.t� ---._ ..._. ../•L:��p r .-�i1..P..n.— -mo........................ ._...�/ ...._. .._...... ............................. ........................ ...... e....._........... r. 2.- ( - ' ; FINAL INSPECTION BY: Date..._.. ................................._•--.........•----.r............. 3/1a17y Com: fm (Treat uda� Prep,.rt+-es SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 134 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,Colifornla Tracy,Callfomia ES 9 REVISED 8.59 ZM 5.62 ATLAS f