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FOR OFFICE USE: t J - Permit No. /..9' . o� dp---- APPLICATION FOR SANITATION PERMIT (Complete in Duplicate) -- ---------- -------------------------------------- Date Issued .--�----------------• _------------------------------------------------------_ 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. �j� �"�' JOB ADDRESS AND LOCAT O --±d�I I(JF_s i�le_ �? /�J '�lT S' tea'/{ t&I s 1� ►��`/�=------------- Owner's Name �4!_/rl �� i > - Phone_ `l�/''.00—/ J FjAvt Address------------ .. -------le�_ r�---49-a-41g� ------------ ----------------•--------•-----------------------------------•-----------------•----------------- Contractor's Name----------- nn --— Phone----------------------------------- Installation will serve: Residence R?-Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _Y-__ Number of bedrooms__ NuribeFof baths rl--_ Lot size --------- ___.______ Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table49; 'flft" Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe [Ee'llardpan ❑ Previous Application- Made: (If yes,date----------- ------.-) No PR New Construction: Yes ❑ No 56o0`1--HA/VA: Yes ❑ No ®r• TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if'public sewer is available within 200 feet.) Septic T*nk: , Distance from nearest well-, --------------Distance from foundation---------------------Material---------._------- ----------------------------- No. of compartments-_ .,`------------------Size------------------------------- Liquid depth.--- ---------- ---------Capacity...------------------•- f /1 �, bisposal.Field,: Distance from nearest well��l�_-Distance from foundation_ __ Distance to nearest lot line_I_5--____._____ l Number of�lines_�___-/.--._______ ength of-'each line___- Width of trench-�..___-_ ll- Jr----------------- -- ®r? ; Type of filter material- _;Depth of filter materialTotal length__ y0_�_________________________ ~ -. `��_____Distance f m fo dation_ �g�►, Seepage Pit: Distance to nearest well___ -_- /r _.��_____.Distance to nearestr�lot I�e_, ,r�___.__ Number-of.pits /r_--------Lining material/ .Size: Diametei._! H- -_D epthv_�tr.-rr�v7L • Cesspool: k,-1, Distance from nearest 'well-----------------Distance from foundation__________________Lining material___.---------------------------- 0 Size: Diameter--------------+----------.---------- --------._E- --Li Liquid Capacity gals _ Depth ---�-�---------- ------------ - [ q p Y--�-------- - -------------- Privy: Distance from nearest well--_----_-------------------------- Distance from nearest building------_______________________.,__-_-__-_. V ❑ 1 Distance to nearest lot line-------- ------------ ---------- ----------------------------- ------------------------------------- ---------------------------- / I _` Remodeling and/orepairing (describe):_.-. ___________ G V --------------------------------;-----------------------------------------------------------------------------•---------------------------------------- ----------------------------------------------------------------- -------------------------------------- --------------------- ----------------------- ----------•--------•-------------- ---------------------------------•-------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws,jand rules and regula+ions of the San Joaquin Local Health District. (Signed)--------------- rtem ��-- ----- ------- ----- --- - ---- --------------------------------------( .Contractor) BY: = "_-----------------------•----------------- ------------ [Title) (Plot plan, showing siie of lot, location of system in r- n to wells, buildings, etc., can be placed on reverse side). F R DEPARTMENT USE ONLY APPLICATIONACCEPTED BY--- - ----------------------------------------------------------------------- DATE------ ----------- ---------------- REVIEWEDBY_�------e!__J---------------------- --- --------------------------------------------------------------------------------- DATE.------- ---------------- ----------------------------- BUILD[NG PERMIT ISSLIED------------------- iiDATE - � -- �/ % ---- --------------------------- - -- Alterations and/or recommendations: mendations:____ � }►r-` -------•--------------------------------------------------- ------------------------------------------- ----------------------------------------------------------- ------- ---------------------- -------------------------- -----------------------------------------------------•---•------------------- ------------------------------------------------------------------------------------------------------------- --- ---------------------------- .._....- -- ------- ------- ------------------------I------ ------- - ----------------------------- ----------------------------------------------------- ------------------------------------------ -------- -------- FINAL INSPECTION BY:----- ------------------- Date--------------- /�---------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT r 1601 E.Ha:elloWAve. y ��_300 West Oak Street ' 124 Sycamore Street w 205 West 9th Street Stockton,California Lodi,California r Manteca,California Tracy,California F.P.CO.