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FOR OFFICE USE: - - --------- /O a------- -------------------------('tea--.----. APPLICATION FOR SANITATION PERMIT Permit No. _.�,��_.��- ------ - - -- --------------------------------- (Complete in Duplicate) Date Issued _____ __ __1,v I _ ____ - 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. JOB ADDRESS AND LOCA ------------ .�� ------ - ♦�!_< ____ ?~ , r ►Ate--------------------------- Owner's Name------------ 1 __ _j_,ES Sa---------- �9 ,e� / -------- --..._ Phone_44_2__-?X/_f.. Address-----------------------L-.-,;;?J61—XV-0------- ------- 7-------------------------------------------------------------------------------•------------------------ Contractor's Name _ ---- 1� 1 l4� I'fi ----------------- ------------ --•-•-------------------------------- Phone__6 i Installation will serve: Residence T--.'Apartment House ❑. Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ i Number of living units: Number of bedrooms _`—_ Number of baths ____�_ Lot size ----------- 0-_X?.___._______________________ Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table -----7-- ft. Character of soil to a depth of 3 feet:'\�Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam [✓Clay I] Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date--------------------) No go"' New Construction: Yes ❑ No ❑i-'_FHA/VA: Yes ❑ No E!�` TYPE OF INSTALLATION AND SPECIFICATIONS: ;; (No septic tank or cesspool permitted if public sewer is available within 200 feet.) • Septic T Distance from nearest well_____.�-______Distan from foundation_--/r0_-____.Material___� (� -______________ I` No. of compartments-_----._�_--_--------- --Size_ Liquid disposal Field:, / Distance from nearest well-------'.--------Distance from foundation__Zf1__ ____.Distance to nearest lot line-Z;6-.____. Number of lines-------------f-__-- -------_-----Length of each line-------- ---------.Width of trench------- -° ------------ Type of filter material---i/A11�_Depth of filter material---jp--__----------Total length___.____.Ae2_!_____.___._---____--__ Seepage Pit: Distance to nearest well------..-----_.------Distance from foundation--------------------Distance to nearest lot line_-.___________.__ ❑ Number of pits----------------------Lining material-----------------------Size: Diameter----_------------------Depth_-------------------------------- 1� Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material----------.--------------------.______ V ❑ Size: Diameter--------------------------------------Depth------------ ---------------------------------------Liquid Capacity----------------------------gals . Privy: Distance from nearest well-------------------------------------------------Distance from nearest building_-_._.____________.________-_____.____. ❑ Distance to nearest lot line--------- ----- ---------- ------- ---------- ----------------------------------------------------------------------------------------------� Remodeling and/or repairing (describe)------4/Q1i --0--/Z-______-5;� 11-_e.-----7,- _____�r _ ___________ . --- - - - ------- f7ddl 1'¢J6-6--------�---- 11' `5 �' - - lQ l Q----C �1ZlJ d Q �' L ��l�------�/n t�'- -------- _:_,00 ------------ - • --- a- I hereby certify that I h e prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws les and regulations of the San Joaquin Local Health District. (Signed)------------------------ - ------ ------ -I_J Lf /---�.�s--------------- -------------------------------- �_ _ r and/or Contractor) Sy=---------------- --- -------- --------------------- ..� ------------------------------------- - -----(Title)-: ------------ -- - -- ------------- (Plot plan, showing size of lot, location of s stem in relation to wells, buildings, etc., can be placed on reverse side}. ,p FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BYn/`-------- -----------'---------------- ------ ------ ------------------------- DATE--------f"--13f`L------------ - REVIEWED BY-------------------------------- - -- - --------------- ----------- --------------------------------------------------------- DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED-------------------------------------------------------------------------------- - ---------------- DATE----------------------------- -------- - -------- Alterations and/or recommendations:_-.-------------------____ . - ----- "------- -- - ` -- -------------------- / wtig. � -- - --1---"--`- ----��s-_-_-_--- �- _ ------------------ ------ --------------------reL ? cd_ ---_ ------- ----------- ---------------------------- _�_e2/f.. t __ __________________ -._____-_._--------.-- FINAL INSPECTION BY-------------el-115,---------------------------------------- Date_--- --x---------------------------- ------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.Co.