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FOR OFFICE USE: ------ � '] APPLICATION FfiR; SANITATION PERMIT Permit No. .__r •--/_. --- ----------- ;rt . _..Y, �7 .__..- {Complete in Duplicate) ° ' ---------- m Date Issued Date Issted ; __`----�-5-- =---•------ - _-. This Permit Expires 1 Year Fro Application is hereby imade to the San Joaquin Local Health District for a permit to construct and install the work herein described. Thic_Anplication is made in compliance with County Ordinance No. 549. .2 3 _ i�1 :1 G i^ . 7�J A-►E 1 . f y� JOBB A DRESS AND LOCATION__._ _ ---.-.-1----/5---r -----;_f I C' . -------------------------- - +' . -- Owner's Name �� . ne--J------------------ P . `��',,// �-f L� - - 1 �-° 0---------------------------------_---- Address------- Contractor's /s L Contractor's Name - -------------- ---------------------•--------------------------- ---- i Installation will serve: Residence Apartment House C1Commercial E] Trailer Court ElMotel ❑ Other ❑ l Number of living units: __1____ Number of bedrooms _ Number of baths _r____ Lot size _ :.. ...... ............ f Water Supply: Public system E] Community system E] Private Wl---Depth to Water Table 4' ft. y ' 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 P----No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: I (No septic tank or cesspool permitted if public rwer is available within 200 feet.) II Septic T nk: Distance from nearest well__`{__-0-..._Distance from foundation__�___��-------.Material. ._________..______._____.____- -_- No. of comparfine.nts--------- Size_t _.Q- o Liquid depth Capacity / J r. Disposal Feld: Distance from nearest well___,r2____Distance from foundation_ --.-_D__`_...Distance to nearest lot line-6l_ __. Z ength of each line- - - _�-��,-.Width of trench-...-.v �-_------ ----- Number of lines--------------------- ---- p Type of filter material-_._-4__'_ (.. -tDepth of filter material-.--- r�_---.-Total length--- l-- --------------__------. ' Seepa e Pit: Dis#ante to nearest weli____4+� __._Distance from ^^fo�nd��a,tion__,l__jC'_.-.__.Distance t nearest lot line_ -�► Number of pits__.,,.__ _- -----Lining material__ `"C.r�ize: Diameter. ._ _ r p De th - ; 1 Cesspool: Distance from nearest well-----_._------__Distance from foundation---------- ---------Lining material.__._____.___________________ -a ___ 9 ❑ Size: Diameter-------• -----------------------Depth-------------------------------- ----------- Liquid Capacity gals Privy: Disfance from nearest well--------------------------------------- ---- ---Distance from nearest building-----------_------------------------------ ❑ Distance to nearest lot line.----------------------W_---------------------------- - ------------------------ ------- --------------------------------------------------------- I � C x. IZmadeling an or repair' (desc`ribe : - 'G' -� -------------------------------------------- ----------------- ------- ------=' ------------- C = : cp -a"- --`�c --------------—�---------- �2'�=�� -��------- ' - -- ------------------------------------------------------------------- ------- ---------------------------------------------------- ---- 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 r ulations of the San Joaquin Local Health District. (Signed) ` ' ------------------------------------------------------------(Owner and/or Contractor) --- ----- ------ - -- By:-------------- Title (Plot plan, showing size of lot, to ation of system in relation to wells, buildings, etc., can be placed on reverse side). t FOR DEPARTMENT USE ONLY may`"`` ------ DATE---- - 3 (� ------ APPLICATION ACCEPTED BY-..---- vC- / DATE-------- ----- REVIEWED BY------------- P'. BUILDING PERMIT ISSUED----------- 1---------------------------------------------------- --------- ---- DATE-_-------------------------- ------- Alterations ----Alterations and/or recommendations:------- - ` L ----- `- �I�_. �_fi -_� j'1.�4- --------------- ---t---------------------�-----------.____.__-_____._..______..____.---------------------------- ---------------- •� �� 0'.W ... --.-.._ ' *' off " s. ------ . L k FINAL INSPECTION BY:---- �//�� 01 SAN JOAQUIN LOCAL HEALTH DISTRICT 1 1601 E.Hazelion Ave. 300 West Oak Street 124S 205 West 9th re ' Stockton,California Lodi,Ca ant ca,Cal ornia + Trac a' o I . h �