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OR OFFICE USE: y G -........ /-a".�Q... �. /3 c,f.....-.-.-- ,t/.:'a.�... APPLICATION- EOR SANITATION PERMIT Permit No. .../��.��1�,/a/�. '_ y( "s. ........... ............�:'i.A. (Complete in Duplicate) Date Issued .°1.1;A4S`_ ......... .................. This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Healfh 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 LO TION........ J._.../../ .. ! -..... 1: .. .1 ................... S d.it/ ......-• ---.. Owner's Name ........ .............. T/IOiI�1J�s�.. Phone. T� .$� Address............................ ........_. .._....... . . .A'�i��'y.....�/� .......................................................... Contractor's Name..._.._..:. . ��.�,�...-...... _..- .__.............. ........ Phone.._ l��P(7fr .? Installation will serve: Residence [Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ..... Number of bedrooms ...3 Number of baths .. Lot size .. ........."" Water Supply: Public system ❑ Community system ❑ Private [!j''Depth to Water Table ........ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam❑ Clay Loam E3--Clay ❑ Adobe❑ Hardpan❑ Previous Application Made: (If yes,date........ ..........) No C3'� New Construction: Yes ❑ No [}• 'FNA/VA: Yes ❑ No E3-- TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance. from neaaresfwell. ............".Distance from foundation..._....._.... . -Material..... .. ............._....___.._...... ❑ No. of compartments...............I...... _Size.......... ...................-Liquid depth......... . .............Capacity-----•---------••-- (� Disposal Field: Distance from nearest well.................Distance from foundation..........-.........Distance to nearest lot line............ ElNumber of lines."."__.............................Length of each line..-......................... Width of trench--......................... Type of filter mater,...;t.....t..�... Depth of filter mate-ial......................Total length.............._:........ .. --------J- Seepag +: Distance to nearest well� r........Distance fr4 foundation_-- Distance to nearest lot line..._.-.. ( r........Dept h"... .�:..�......_._... v Number of pits........../........Lining material. .rAwt _-Size: Diameter. �3. Cesspool: Distance from nearest well................Distance from foundation....................Lining material..........................-........... Size: Diameter................ .......... ......... Depth. .......... ..............................._...Liquid Capacity-----_...- gals. Privy❑-. Distance from nearest well............ .........Distance from nearest'building.......................................... ❑ Distance to nearest lo' line........................ ...1-........... ..........-........-.............r -i-- -------------------------- -•-•-•-•-----• r Remodeling and/or repairing (describe):..._.- .. �Xl--�-r-<�! - _.. �'••'--••'•'•' �_ _ _.... ........................................;................._...._.....,.......-_._............._..._. ....................................... ....................-.....---......._-._._._............_._.................................. I hereby certify th have prepared this application and that the work will be done in accordance with San Joaquin County. ordinances, State laws an rules and regulations of the San Joaquin Local Health District. ` --.. r or Contracto (Signed)................. .:..r.... ... ... . _... BY (Title).. _...... . .....�._.*............ ':.. .;..-.. _.. (Plot plan, showing size Zo�t, ocation of ry em in relation to wells, buildings, etc., can be placed on reverse side)." FOR DEPARTMENT USE ONLY ..... .- .". -- DATE_..... ��-1- 1� Q...--- .--... APPLICATIONACCEPTED BY.................... .. -•----...........__........._............._. REVIEWEDBY................................................... ....... .....--- DATE.......................................................................- BUILDING PERMIT ISSUED.......... ------. "" _ .. XTE............•- / �' sl.r. ........-. Alterations and/or recommendations:.._... !�.�� stJ� - "- "�"".Alt_ -p'�``��" "' �6. - / t y.-!t*•�gc{.__A". _.._QIII.N'.�/.. ..-�y.--t�:i✓...�st. ,r.... .:_.__. ./.iA6il..../GcP•... .. ( - " FINAL INSPECTION BY.-. , ,/.. .... Date....... ............... -......... ................. ._. �!.._...-"••-__•--.-"•.••-•"•••-•• Ol A CAL HEALTTH DISSTRICTCL} ry 1601 E.Na:alton Ave. 300 Wast Oak Street 124 sycamore Street 205 Wort 91h street Stockton,California Lodi,Callfornia Manteca,California Tracy,Califoorniia ACV