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OR OFFICE USE: J ,------- ----- - ..f��. { APPLICATION FOR SANITATION PERMITPermit No. ------------ --------------------------------------. (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 descrA N_e) This application is made in compliance with County Ordinance No. 549. / - �, ry�fsY� 2 7 9LO S - JfjI JOB ADDRESS AND L CAT10N__ t l --=---------------------------------------(_9--7 --------------------------------------------------- 4 � --- --------------- ----------- ----- - Ph 1_/V'/ dr Owners Name--- /JJ ..-_ r,L �+/ Ad d ress---------------- ----------- Con#rac.tor's Name �- Phone - ---------------------------------- ------ Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court C] Motteel�- I Other ❑ Number of living units: j--- Number of bedrooms —:_____ Number of baths Lot size __.___//__- a-. - ---•-------- Water Supply: Public system F-1Communitysystem E] Private �epth to Water Table -4,42.1- ft. Character of soil to a depth of 3 feet: Sand El Gravel ❑ Sandy Loam F] Clay Loam ❑ Clay ❑ Adobe �ardpan ] Previous Application Made: (if yes,date--------------------f No New Construction: Yes [i to ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: I e (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic�Pank: Distance from nearest well__ Distance from foundation._.L_d----------.Maters;--C-CfjC-y -.-.-.�--- No. of compartments_---------�---------Size__ X--� ---Liquid depth___4�__._.______- Capacity__.,�a�� _. M �d. ----- x.------ :t Distance from nearest well___--__-Distance from foundation__-.- _ t-Distance to nearest lot li/a____ Number of lines_._.________NS Length of each line "� If0.Width of trench---._..a Type of filter materiaSA _?fCkDepth of filter material____-_.__�---..--Total length-_____ 7-�-v----------------------- a Seepage Pit: Distance to nearest well------------- from foundation----____--________.Distance to nearest lot line_____...--.___._ ❑ Number of pits----------------------Lining material---------- -----------.Size: Diameter--------------......---Depth--------------------------------- E 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 ..._._-______--____________._._. ___._.Distance to nearest lot line--- ------------------- -- ------------------------------------------- Remodeling and/or repairing [descril6e):-------Ce-.! s1 ----------•-------------------------------------------------------- ----------- ---------------------------------------------------------------------------------------------- ------ .�"t w ------------------------------------------------------------------------------------------------ ----- - I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, . at laws, and rules and re ations of the San Joa u' Local Health District. [Signed _ ______________(Owner and/or Contractors 'I By: . _ (Title)---------------{ )--------------- -- ----- -- -- ------ (Plot plan, showing size of lot, location-of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----. -�_6�--------------- -------- DATE is -4l _64REVIEWED BY--------------------------------- DATE---------------------------------- ---------------------- BUILDING PERMIT ISSUED--------------- ---- -------------------------------- DAT --------------------- --------- •----------- Alterations and/or recommendations:___ - 4- ----.lr—- ----- 4� �� --------- J / ---- -l4��-.-CF_ - - -- �G6Cl1 LLQ 4 � --�---- ---- c.--- Q -- --' •f- - -t- ----------- ---------------- """ FINAL INSPECTION BY------------- �------------ ------- Date = ��- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.fta:elton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California r.P.C C. fJ