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FOR OFFICE tIS&- --------------------------------- -- -- -------- APPLICATION -FOR SANITATION PERMIT Permit No. ----------------------------------------------- (Complete in Duplicate) - -_. - .. ... This Permit Expires 1 Year From Date Issued 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 compl' ncerwith ounty Ordinance No. 549., 2`fS- /(oo- O'f �D� JOB ADDRESS AND LOC I KTO/J� F 9 OF----L��f�-�P�---- - Owner's Name------•---- JLZ- ---. ---------- I -------------- --------- --- ---------- ------ - Phone----------------------...----:----.- —r- Address ' Q . C`� �--_------R��P ------------------------------------------------ a oil ,I Contractor's Name A 0 144 --6 `� _`- �I�J - --------- --------------------------------- Phone-------------------------------- Installation will serve: Residence .Apartment House Commercial [a Trailer CouO❑ Motel ❑ Other ❑ Number of living units: _ .-_-- Number of bedrooms3---- Number of baths Z Lot size ----- X---IS. .------_---_.--._ 5 a Water Supply: Public system ❑ Community system ❑ Private FrDepth to Water Table Z57 ft. Character of soil to a depth of 3 feet: Sand Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date---------------------) No New Construction: Yes No E] PHA/VA: Yes Iff' No ❑ f r TYPE°OF-INSTALLATfON-AND-SPE0F1GAilONSr -" "" —T" -� (No septic flank or cesspool permitted,if public sewer is-available within 200 feet.) Septic Tank: Distance from nearest well---50Distan e'from founj ation---�Q------. t �+_ - Ma a �al_CQlVC .--ETA-..----- n � No, of compartments-----.. .--`--.----Size._.-. - . 43__'Liquid depth -r�._Z.......--Capacity.------------------' � I r� Disposal Field: Distance from nearest well_--,S()-±-" Distancetifrom�foundation:�-t�_--.--__.Distance to nearest.lot line---S.-- Number of lines--_ - -- _ .---.---'--_'Leng,tht bf..each .-- Width of trench..-_.-3 �r--_ 1 1 Type.of filter material -:�K,_ Depth of filter material------- --..-_---Total length----------- ---------------! N k . Seepage Pit: Distance to nearest`well'-'-...-".'--. :'Distance from-foundation------------------- DistaQce to-nearest lot line----------------- I ' Number of ,ts ^'' ---.Linin material_.-----------_- Size: Diameter.--.':----------- Depth S, P - p "-- "ro. r from foundation _Lining material--------------- - s .._� . � .--- - - - -------------------- Cess ool: Distance from nearest well____-----__-----Distance ❑ Size: Diameter--------- -^:,.---- ----- Depth-----------------------------------------------------Liquid Capacity--------------------------:.gals. i Privy-. Distance from nearest well ---`. ---- --. y Distance from nearest building----------- --------_- ---_.-------. . ❑ Distance to nearest -- ---------------- Remodeling and/or repairing (describe):....-: - ----------------- •----------------------------------- I------------ ---------------•---------------------------- F ` "'� 11�* i .--- , ------------------------------------------------------------------------------•---------------------------------------------------- --"----._----------- 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 regulations of the'San Joaquin Local Health District. i ,ry_(Signed) : � � - �.. _n - ------ --(Owner and/or Contractor) BY= = (Title) ��t � � �. (Plot plan, showing size of lot, Iocat' of system in rotation to wells, buildings, etc., can be placed on reverse side). t ' FOR DE! i"ENT USE ONLY APPLICATION ACCEPTED BY----- / :- 0----- ------- ---------------------------------------- DATE---------le: Zq--7 46 � . REVIEWEDBY- ------------------------=------=------t-------------------- --- - ---- - ------------------------------------- DATE-------------.--------------------------------------------- BUILDING -- -- ------ --------------BUILDING PERMIT ISSUED-----------------------------------------------------------•--------------------------------------- - DATE-----"- --------------------------------------- , Alterations—and/or rec m mendafions:" -—..- _ = = = A - - "� ---- ------ -------- , /, � --.-.-I� -1�} ��1 *_�Ct�'� .�-�M -f�------- � - _- ,t--. ----_----------------- � ----- -- . : .�,. _. --:- � ..� ---- , 3 ------•------------------ ----------------- t -------. ......---,(•---•-----•'--•------•---- ------------------------------------------ - ------------------------------------------ .----FINAL INSP ON BY:. ---- - - r Date-------..-- SAN JOAQUIN LOCAL HEALTH DISTRICT y 1601 E.Haxelton Ave. 300 West Oak Street 124 Sycamore street 205 West 9th Street Stockton,California . Lodi,California Manteca,California Tracy, California t