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FOR OFFICE USE; s ��------ _ ---- --� - -------------- ------ ------ Permit No. --- �� l� � APPLICATION FOR SANITATION PERMIT 1 (Complete in Duplicate) .3_1 -.--._..-- --------- 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 comp fiance`with County Ordinance No. 549. JOB ADDRESS AND LOCA -------�-�'. ..5--------,2--t----- /�I„SJ--------------(-V-4-0.4 7 fin ",f �i !- o7 1 �' T' /1l Phone------------------------------------ Owner's Name-------------- --- Address---------------------------- ----------/.e.4-7--------%.-4/...... -------------- Contractor's Name—�� _.4114 -------------------------- Phone Installation will serve: Residence [D/�{partment House ❑� Commercial ❑ Trailer Court ElMote1 ❑ Other [I Number of living units: __C--- NU'mber of bedrooms --- Number of baths -�---_ Lot size _---._-.1+- _. le-----f.--------------- Water Supply: Public systemommunity system ElPrivate [-1Depth to Water Table 460- 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 te------------------ -) No 2�` New Construction: Yes E4-<oo ElFHA/VA; Yes J-] No E�1" TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic T k: Distance from nearest well--.----- ----Distance from foundation-../�-------_Material----_�C 1 E-�� .-----T--------. No. of compartments....---.7�----------Size--�rtr�`c c'..!_----Liquid depth-___.5_ Capacity--- --��1 ,?=Q-�-__Distance to nearest lot line----5'---/ field: Distance from nearest well-.-.----�-Distance from foundation---- -.. `� ' Number of lines----------------- -- -------------Length of each line------jlf--o------------.Width offrench------�0.------------------ Type of filter materia!-__� G��Depth of filter material_-/�"----_-Total length---.-.-.y�- ------------------------ Seepage it: Distance to nearest well----.- ---_-__Distance fr m foundation---AQ..........Distance to nearest lot line--.,.5........ Q Number of pits....---/------------Lining material--��!�--Size: Diameter--.. ��.'�._--_-Depth-.-.¢Z4--r...............` I f� Cesspool: Distance from nearest well- _.--Distance from foundation....................Lining material -.____-.-------------------- ---- --.�Q ❑ Size: Diameter----)---------------------------- ----Dept h----------------------------------------------------Liquid Capacity------------------------- 9als. -,_----.---- from nearest building ----- . Privy:' Distance from nearest well--------------------------- 9----�----�-- ---------•--------- - ❑ Distance to nearest lot line-------------------------- ----- ----------------------- ------------------------------------------------------------------- V Remodeling and/or repairing (clescribe): -44J-- ------ .51 �-.��-------•--•----------------------------------------------- -- p`p ------------------•--------------------------- ---------------------------------------------- --- f -------------------------•- ------------•--------------------------------..---------------------------------- �. . ------------------------- --- ------------ ----------- ------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County V+ ordinances, State laws les and regulations of the San Joaquin Local Health District. .. i (Signed) s - - fvr-- ----------------------------------- -- ---- er nil/or Contractor) By: (Title)--- ------------- -- ♦ ---- -- t (Plot plan, showing size of lot, location of sy m in relation to wells, buildings, etc., can be placed on reverse side). r t FOR DEPARTMENT USE ONLY I APPLICATION ACCEPTED BY ------------------- DATE------c jam`/ ---------------- I ------------------ REVIEWED BY. -- --------------- DATE------------------------------------------ ----------------- -- --------- -------------------------- - - BUILDING PERMIT ISSUED- - DATE Alterations and/or recommendations:--. _ .. --------------- 0��'' . ©t�l-------- ---- ---------------------- -------------------------------------------------------------- ----------------------------------------------------------------------------- ---------------------------------------------------------- ------------------------ ---------------------------------------------------------- ------------ --------- -------------- -- --- -------------------------------- -------------------------------- -------- r Date -FINAL INSPECTION BY:-.- ---- SAN JOAQUIN LOCAL HEALTH DISTRICT 1401 E.Haxellon Ave. t 300 West Oak Street 124 Sycamore Street 205 West 9th Street " Stockton,California ik Lodi,California Manteca,California Tracy,California 1