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' FOR OFFICE USE: --- ------- APPLICATION FOR SANITATION PERMIT Permit No. .a � � 13-�- � _-'---d p_- ------- (Complete in Duplicated Date Issued -_ � - --- -------- --- This Permit Expires 1 Year From Date Issued .. I . �t 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 O inance No. 549. JOB ADDRESS AND LOCATION...Q - _-----!' ------------ --------------- ---------• -------------- ----------- ---------- Phone---------------------------- �� Owner's Name------- ��------ ---1" ,S' _ ll_. Address---------------- ---- ---- --------------- Contractor's Name--------- -- ---- >�-«----� � �------------ ----------------- --------------- -----•------- - Phone-------------- •---------. ------- a Installation will serve: Residence ®" Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: --/-- Number of bedrooms _a_ Number of baths Z----- Lot size ---------------- ------------ ► ._ i Water Supply: Public system Community system [I Private E] Depth to Water Table _.-�ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe XKHairdpan ❑ Previous Application Made: Ilf yes,date.--------------- ----1 No New Construction: Yes ❑ No 2�— FHA/VA: Yes ❑ No Z- TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.)_ Septic TarA- Distance from nearest+weil-----------------Distance from foundation------------------ Material------:------------------------------------------ A--Xy /- /// depth--------------------------Capacity----------------------- ��dJ N6. Of COmpartmentS--------------------------51ze------------------------------ Liquid Disposal`Fiel/dj Distance from nearest well------------ Distance from foundation--------------------Distance to nearest lot line.-_----._------_- 5��` l Number of lines.--------- Length of each line Width of trench Type of fitter material-------------------------Depth of filter material----------------------- otal length__--________------ ------�®------ Seepage Pit: Distance to nearest well-----�--------Distance fro�A,fou�u datiori-;&.-_.__--Distance to near est lot line _______________ r�-,� Number of pits.-_.f-------------Lining material--/ lL/ --Size: Diameter-_- 3�---.---.Depth "o�e1'�� ------- Cesspool: I Cesspool: Distance from nearest well________________Distance from foundation--------------------Lining material.-______.._-___.__._.__."_______.__. r-1 Size: Diameter-------- --------------- ------Depth----------------------------------------- -------- Liquid Capacity - 9als. Privy: Distance from nearest well------------------------------------------- -----Distance from nearest building--------------------------------------- ------- ❑ Distance to nearest lot line------ ----------------- Remodeling and/or repairing (describe);,._.-------- ----- yGl F �� ------------------------- ----------- ----------------------- �� ...e c.?ir.✓ p--./ � -[fes ------------------------ - l lei// Cc r T ---------------------------- -- ------ I hereby certify that 1 have prepared this application and thail t the work wl be ne doifl accordance with San Joaquin County ordinances, State laws, and rules and regulations of the SaSan �Joaquin Local Health District. (Signed)--------- ------------ - "- � ----- --- ------ - -- ----------------------- -------------- ------[E)wngr3md� G Contractor �j/�� --- - ----- - ----------------------(Title)--- fir7f1;Aoll `. 1 (Plot plan, showing size of lot, location of syste i relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---- ------------------------------------------------------------------------- DATE------ ".. / ,g----------------------- REVIEWEDBY------------------ --------- ---- DATE------------------------------------------------------------ D,A PERMIT ISSUED---------- _ D T Alteratio an /or recommendations:---.-._.. ------- / p ` - f ,�� - -� -------------- - _ ----------- --- ----------------- --- ------------ ----- 34 FINAL INSPECTION BY:......C..1___ 4 -- Date...-_ �—_34 4 y SAN JOAQUIN LOCAL HEALTH DISTRICT 1401 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street ` Stockton,California Lodi,California Manteca,California Tracy,California t-.R.co.