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r F R OFFICE USE; !} ----------- } Permit No. __!-._/.-G.�-- _ APPLICATION FOR�SANITATION .,PERMIT -_-------------- (Complete in Duplicate) Date Issued - / -1-�?-� ------------- 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 described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION- -------•------------------------------------•-------------- 1 iOwner's Name--------- � - ------------------ Phone------------------------------------ $ ------ Address---------------•---41�-r ------0- - -- ... --- --- ------- ----- -- -- - Contractor's Name-------------- "'.�4421------- F 1 * --------------------------------------=------------------ Installation will serve: Residence 2- Apartment House'o' } Commercial`❑ Trailer Court ❑ Motel ❑ Other; ❑ Number of living units: Number of bedrooms _9V Number of baths _Z-_ Lot size .f. __-- ------------------- Water Supply: Public system P— Community system ❑ Private ❑ Depth to Water Table -------- it. Character of soil to a depth of 3 feet: ;Sancl Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ ❑ Previous Application Made: (If yes,date_...._-------------) No [5' _ New Construction: Yes E] No a FHA/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----------------- from foundation------------_------_Material--------_.__...-- ___.__--.-____._--_. ' No, of compartments---------- - -------.--Size.-------------------------- ALiquid depth--"-------------------..Capacity-------------- -------- Disposal Distance from nearest well___ V-o---_-__D.istance-from foundation___.-/-0----_"" Distance to nearest lot.line__S---------- Number of lines------- ---------------------Length of each line--------- {1__r----------Width of trench------Z--•_---------------•------ Type of filter material__- />'vcA----__Depth of� filter material--------!.Y ...;....Total length--------- ------------------ --- i, i.,___.Distance to nearest lot iine___' Seepage Pit: Distance to nearest well----LVv ---- --Distance:from foundation_____/_J___ _...___.- T �r Number of pits-------- ------------Lining material----/Qa_c --- Size: Diameter---- -- - ----Depth----- _5.______-.------------- . Cesspool: Distance from near wail_________________Distance from foundation.._..._...-..____ Lining material--------------------------------..__ Size: Diameter---------:`.----------------------------Dep-W.__ .. --------------=----- - --------------._.Liquid Capacity------------t ❑ � r Privy: Distance I nearest well------------------------------------------ ------Di I stance from nearest building----------------------------- .__..__.._. �. ❑ Distance to nearer - --------- ---- --------'---------- - --------------------------------------- --------------- - - - 4 e t Remodeling and/or repairing (describe) ----- --- ----------------------------------•-- i ------------------------------------- ------- ----------------------------------------- .- -_ t --------------------------------------- ------------------------------------------------ - f .. --- -------------------------- I I hereby certify that I have prepared this application and that the work will be done in accordance with a Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. 1 N -----------(Owner and/or Contractor) ' ./✓-� ---------------------------(Title)--------- ---------------- ------------ --- - ----- --------- (Plot plan, showing size of lot, location of system in relation-fb ells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY,' APPLICATION ACCEPTED BY --� 4' :;--= ----- DATE----------- -tet�— F !- DATE---•---- - ------------------------------ ------------------- -------------------- -- DATE----------------------- ns and/or recommendation --- - ---------•--- ------------ s BUILDING PERMIT ISSUED-------------- f�- � - ------.-- �_'---��_ •� �-._ r -_. --------------------------------------------- --- Alteratio / � -- -------------- ' ----------------------- --------- -------- -------------------------- l - '"------------------------______________________________________________ FINAL INSPECTION BY:----- �..... .. `� - --------- -- Date ._`Z..IP_'-�P-�� ------------------------------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hoietion Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street It Stockton,California Lodi,California Manteca,California Tracy,California