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� sR OFFICE U SES --------------- dg 3� jO6 '. .d . APPLICATION FOR-SANITATION N PERMIT---- - -- ------- Permit No. -Zp --------------I--- ------------ ------------------------ (Complete in Duplicate) Date Issued AQ!��S.r�S --------------------------------------------.--- This Permit Expires i 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 Ordinance No. 549. 3�300 10 Z/3 q _ �<- '- . -.. JOB ADDRESS AND LOCATION.................. Ate/.... _-___ ' ___Ca � . � -------------------------- Owner's Nam s" ------------ ----` c.�c� -•----- --- ------------------ - -------------- Phone--------------------••--•-----••---- - ------------------- 49 Address----- --•.....�•-------....,s Contractor's Name............ ..... Phone.. installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: :___- Number of bedrooms __2__ Number of baths ---L Lot size --------- ' ./ ---------------- Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: San 10 Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,dote__._.__..._..___._I No'jK' New Construction: Yes No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well....._---Distance from foundation___ ..-..-..Material... ... L ....�............. 4 No. of compartments--------- -----------Size------ --.--.- --Liquid depth-------- C��- --- _- -I Disposal Field: Distance from nearest well.. .f...Distance from foundation_.. rid. ....Distance to nearest lot line---- Number of. lines---------,7,--------------------Length of each lire---------------------- -- --Width of trench.. ._.Qyiz.-`_,.------- Type of filter material---AC;& ..-..:Depth of filter materia ..... length--/ --------.-. Seepage Pit: Distance to nearest well----------------------Distance from foundation-------------.......Distance to nearest lot line------------- ❑ Number of pits---------------------Lining material------------------- ---Size: Diameter.--------.-------------Depth---------------------------------1<1. Cesspool: Distance from nearest well-----------------Distance from foundation-------------------.Lining material_._.___------.-------.-....._-------.. ❑ Size: Diameter - ---------------------------------Depth---------------------------------------------------Liquid Capacity- -------------------------gals. Privy: Distance from nearest well------------------------------------------------ from nearer# building-------------.------._.___-_____.______- ❑ Distance to nearest lot ' line-,----------------------------------------------- ----------------`---D----/-�--�----.-�----r-------(--/--- -------.--------L------G-r--�-F--f-�-------------------f_- Remoing and/or repaidestribe):--6.o.. , f L• ------ ----- ------------------------- -------------- ------------------------- ---•------------------------------------------- -- ---------- --------------------------------------------- -------------------------------------------------•---------------------------------------------------------------------------------------------------------------------------------------------- ------------- 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. E (Signed)---------------- ---------- ---------------- - - -- -------- (Owner and/or Contractor) - --- ---- - --------- ------- --------- 1 TitleBre-------- --� •-------x-- ------------ ---- - ------- - - ---- -- -----------------------------------------------------{ ) (Plot plan, showing size of lot, location of s stem in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED $Y- - DATE rd's "�`-� -- ---------------------------------------------- REVIEWED BY------------------------------------- ------ DATE BUILDING PERMIT ISSUED__---------------------------------------------- � - -------------- DATE--------�------------------------ ----------------------- Alterations and/or recommendations:.-.. -Qr-- J- . .. . . ... _------ �. .... �d: 96-�________________ ------------- ----------------- -------------------------- ------ - ----------------------------- ----------------------------------------------------------------------------- --------------------------------- -------------- -------- ----------- -------- - I - -- - --- -- --- ---- --- - ---------------------------- -- ---- ----------------- p `• FINAL INSPECTION BY �` - Date......`�r...' ~ 5 SAN JOAQUIN LOCAL HEALTH DISTRICT 1401 E.Hazollon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9111%Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.0 o. +