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------ - ---------- ---------- ------------------------" APPLICATION FOR SANITATION PERMIT Permit No. ._1_.k�/`,_ -------- -------------- --------------------------------- (Complete in Duplicate) ---------- ----------- . Date Issued --4/1/ 5J. ------------ -- This Permit Ez ires 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 Or -mance . 549. JOB ADDRESS AND LOCATION-__-_,fes r- •-c--c------- 5 Owner's Name -------------------•------- .. ------• -- •= F,vrstrWk Phone�j'=- 4.__.Phone---------- ; Address-------------- i _ �?--,� 1 YY �A- - ;!"i 7--------------•------------------------ Contractor's y ----------------------- --- Phone... ___ 76 y-- z-- Installation will serve: Residence ❑ Apartment House ❑ Commercial []Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -------- Number of bedrooms -------- Number of baths" :___-4 Lot size -----/.9-q 1 �_ Water Supply: Public system ` �* �-•--�-� ' Pp Y' y Community, system ❑ Private ❑ Depth to Water Table _._-_.._ ft. Character of soil to a depth of 3 fet: FSand F] Gravel ❑ Sandy Loam E] Clay Loam El Clay ❑ Adobe Hardpan E] Previous Application Made: (If yes,date------_- --- --- No � ,. Q" New Construction: Yes [�- No ❑ FHA/VA: Yes ❑ No E— TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or.cesspool permitted if public sewer is avai_ _lablIe within 20__0 feet.)_ ` F Septic Tank: Distance from nearest well-__ o----_---Distance rrom foundation___14._______.__Material__--�o.s-�-r_� No. of compartments--------Z_-___.------Size----J-A-'F:*j.-`----Liquid depth------t -----`---------Capacity--B'oa I Disposal Field: Distance from nearest well--- Distance from foundation___!V_--_..____.Distance to nearest lot line---,f".1_.__--- [1 Number of lines-t._.........1----------------------Length of each line----------o '--_---_.`Width of #reach.----"--Z !----------------- V/ Type of filter material__- o c_. ------Depth of filter material_.--7_s'-'r� - Total length `7 r----------------------- J Seepage Pit: Distance to nearest'well____IYa_______-----Distance from foundation_ -'Z!_ ---------Distance to nearest lot line.—i'7 �— Number of pits... /_-__-__---_.Lining material----Roe-/'�___51ze: Diameter._-r7 �� 1 Depth Z' --------------- m Cesspool: Distance from nearest well-----------------Distance from foundation---._..___-"-__-._ . ------------------..Lining material-----------------------------------•- Size. Diameter--------- ------==---- ----------Depth-------- --------�---- ----- ---- ------------ -Ligwd Capacity ------- ------------ ----gals. Priv i Y e from nearest well------ _-------------------Distance from nearest building_______-_._________----__- ❑ Distance to near' - ----- - ---- ----------- ----- - -------------- --- f Remodeling and/or repairing (describe)_________________-------------------------------- •-------------------------------------------- ---- ------------------------------------------------------------------------- ----- ------------------------------ -----------•--------------•------------------------------- ------------ hereby certify that Ihave ----------------------------- - ---------- ------------ -----'------ - Y y prepared this application and that the work will be done in accordance with San Joaquin County 3 ordinances, State laws, an rules and{rer gulatons/oftin Joaquin Local Health District. (Signed) I 4 -F ------- � (Owner By:-------------- - --- - -------'•- =------- --- ------'------ ------- - and/or Can ract d/o t or) --------- ------(Title)------------------------- ............. --(Pl --- l" of 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----- REVIEWED BY---- -------- --------------------- --------- DATE ------------- UILDING PERMIT ISSUED------------ ---1 --------------------------------------------- ---------------------------------------------------•-- ------------------------------ DATE----- --------------- -- st _ Alterations and/or recommendstions:._ _ -.!_ - ,---- $---- )------ a q---- -- $ Z� f----- --- ---------------- --------- p 1 ------------- -------------------- ------------.------ ---_------------ ------------------------------------------------------------------------------------------ ---------------------------- ---------------------------------------- t; - ----------- -------------- - FINAL INSPECTION --------------- ---------------------------- ----------- -------------- SAN JOAQUIN LOCAL`HEAI_THyDISTRICT 1601 E.Haxeltbn-Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,Californias Lodi,California Manteca,California Tracy,California S4 L