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FOR OFFICE USE: SA �1 �.__.___- __ _�___ _._ APPLICATION FOR S -�" q �SANITATION PERMIT Permit No. "�"�.7---------- ------ ---------------------- ----------- (Complr)te in Duplicate} -- Date Issued -- -----.--- __ _ _ ---------------------------------- This Permit Expires 1 Year From Date Issued OleS p2A-1a!S I Application is hereby made to the San Joaquin Local Healthy District for�a�permit to construct and install the work/pR'a ein de n d. k This application-is made,;n comnlinnce with County Ordinance No. 549. d V 1, 17 JOB;A RESSAND LOCATIONQ1------- ff ,. r Owner's Name----IBX --- Phone. Address-------••-.-3-Ol_v ---a �/� �------------ -- -- ----� ------------- ------------------ ------------- ------ Contractor's Name------------ r74 Phone t�' " /"` Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer • t �Mot�el ❑ Other ❑ Number of living units: __/__ Number of bedrooms A -" Number of baths J___ Lot size -'----------------- Water Supply: Public system E] Community system ElPrivate Depth to Wafer Table .frft. 1 Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan g?— Previous Application Made: (If yes,date---------- ) No 0 ' New Construction: Yes ka"No ❑ FHA/VA: Yes tom' No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: k (No septic tank or cesspool permitted if public sewer is available within 200 feet.) �q or �� - --- Material_Cr_�_4s� " - ------- �' Septic Tank: Distance from nearest welL_S _Dist nc from fF�undati on_ ___ _ ' -- - - - �� f2--, iquid depth_--- �----- P Y No. of compartments__..___ �Si ___ _______- Ca acst _ __�"----. t � r f w. Disposal Field: Distance from nearest weh-wilo._-_ Distance from foundation, :._.____.Distance to nearest lot line Number of lines.-_____/____._ ength of each line_f�ff"" Width of trench. ""-- -------------------- Type of filter material-41e, ._ epth of filter material__ V-____.___ Total length___ ______________________-_ M , ________.Distance to nearest lot line_________________ I Seepage Pit: ;Distance to nearest well__ ��-_D�stance f m fo ndation__�� _ --Size: Diameter_ i Ifs Number of pits ma#eriaL .. _ �-----------Depth_�.�.---------------------- Cesspool: Distance from nearest well_________________Distance from foundstion-------------------.Lining material_.___.____________.______________.. Il W . ---Liquid Capacity Size: Diameter------------- ------------------------Depth--------------------- - --gals. _____________________x___. -- - - `----Distance from nearest building.__._-..__.___-----________-----.-.----"".,j Privy: Distance from nearest well______ ❑ Distance to nearest lot line-------- --------------- ------------------------------------------------------------------------------------ ----------- -Remodeling -Remodeling and/or repairing [des cribe):----Lai% !/sc�j " '� f ------------------ -- ----- ------------ t ----------_-----•------------------ --- -------------------- y- 3 --_--�-- e # ------------- __________________________________________________-________- _______-________________-_________.________-______________.-________________-_______________________________________..__-_.___.._-___.._____-_.._ 4 ti� 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, and rules and regulilltions of the San Joaquin Local Health District. Sined ---- -------- ----------------------------------------- - Contractor} -- --------- ---------------- ---- }Title}_ ------------ -- ....... I (Plot pian, showing size of lot, location of syst n relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY --------ru ---------- DATE---/ L��------------------ APPLICATION ACCEPTED BY_ / 1 REVIEWED BY----------------------------------------------------------------------------------- ------- DATE------------------------•----------•------------------- BUILDINGPERMIT ISSUED_--------------- ---------------------------------------------------------------------------------- DATE- - Q Altedo aendations: " "" ----- _--�-------Y------------------ ----- ----- FINAL INSPECTION BY---- - - --------------------------- -- A: , Dat ------------------------- SAN OAQUIN LOCAL HEALTH DISTRICT + .. > �� �. 1601 E.Iia:olio.Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California