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FO OFFICE USE: w, J Permit No. .__l -7..... ---- �----` ` 6 y _� APPLICATION FOR 3ANITA_TION PERMIT _------ ----------------- (Complete in Duplicate) Date Issued ------- This Permit Expires 1 Year From•DatelssueI - 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. �� y �� 44 la-JOB ADDRESS AND LOCATION-------1?�--� //- -- h /.........r.-5� l r&� -- Owner's Name--------- --------- --------- Phone------------------------------------ Sv/ - -- Contractor's Name------------------------------ ------------ 1�. -il. -----------•---------------•-------- - Phone----------_----- -- ---------- Installation serve: Residence-[►��partment House ❑ Commercial ❑ Trailer Court ❑ nnMotel ❑ Other E] Number of living units: _-_/,_ Number of bedrooms -_--- Number of baths _ Lot size --- Water Supply: Public system ❑ zCommunity system ❑ Private EiaDepth to Water Table k, ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 2-1ardpan ❑ r Previous Application Made: (If yes,date--------- ----------) No [ New Construction: Yes No ❑ FHA/VA: Yes [j,-`No El TYPE OF INSTALLATION AND SPECIFICATIONS: -� (No septic tank or cesspool permitted if public seer is available within 200 feet.) ;s Septic Tank: Distance from nearest well _-�a__- Distance from foundation.--f_6_f___. _Mate ria3.-" -" ._ =r�_1"-C-,�C°'--------------- of compartments---------�------•-----Size--- - �-D Liquid depth.. "� / Capacity.. �<- ------- No. i t=_ Distance to nearest lot line-=�.i----"_ Disposal Field: Distance from nearest well_�i�"___.-"._.Distance from foundation �-� l of lines---------- -_ .----Length of each line---:---- Width of trench."_ '_!_---------------------- Number �---------Total length- r ---------------------------- � Type of filter,material-"__�_��r=!c'Deptn of filter � t ----- Seepage at: D istance to nearest well__i!_Q"-"-___-"_"__Dis a #` ..___ Distance to nearestlot line"- T� 0.4�_.Size: Diameter_"_<�?-7.{f _._.__D ---- __ Number of pits.-__".. Lining material--__ �''`---- Cesspool: Distance from'nearest well-----------------Distance from foundation-_-_.--------------Lining material_--._-_-..__,.----.,-Y.------------ O ❑ Size: Diameter--------------------- ----------------Depth----------------------------- ---------------------Liquid Capacity--------------------- gals. ., d.,:.... - _ _...ter.....--_.��.. Privy: Distance from nearest well------------------------ Distance from nearest building-___----..-----.------__---_---- ------ Distance to nearest lot line------'-------------- ----------- ----------- ❑. � ----------- y ,� p -" g . g escribeJ------- =------- ---------------------------------------------------- Remodelin and/or re airs d I _ . ------------- ---------- ------------------------- --------------- v --------------------------------- 1 --•----------------•--•_-_--------•----..-------------------------- -------------------------------------------- ---------------------------'-------- -•--------------------------'------ I hereby certify that'1-Iieve prepared Ellis ap'p'lication and that fie vrork wdlTbane in accordance wi#h San Joaquin County ordinances, State laws, and. rules and regulations of the San Joaquin Local Health District. (Signed) ------ ---------'------------- ---------------------------------------------------(Owner and/or Contractor) ---------------(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•�.I DATE `{ REVIEWEDBY----------------------- F ---- ------------------- DATE------------------------------------------------------------ BUILDING PERMIT ISSUED---------------------------------- -- DATE -------. ---- - Alterations and/or recommendations:._1 arti-4� '= i"1'YI - ------- -� - - ------- ---------" --------------------- -------- ------------------------- = --------------- ---------------- - ---------•-------------'-------- ------------------------------ -------- -------------- --------- ! - 1 FINAL INSPECTION BY:-`iJ--. ----- Date__-..".. SAN JOAQUIN LOCAL HEALTH DISTRICT 1401 E.Hasellon Ave. 1 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.GO.