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FOR OFFICE,USE: APPLICATION FOR SANITATION PERMIT Permit No. ------ `_ " ------ ------ --------------------- (Complete in Duplicate) . Date•Issued ___ .... ............ This Permit Expires 1'Year from Date Issued xt Application is hereby made to the 5an 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, ci) c 3 , J06 ADDRESS AND LOCATION_.----(- - � � 1.' ,= l�_ � L�-�� R-. F L1--f 1.� 1�-1�1. 1-(_J��[�`!_ �_ ''' -- -- ---- -------- Phone------------------------------------ wner s Name----------------- ---- •• -------- .' �? - ---------- --- - ----------1�' i ,.r Address-----------------/Z(-�----------5-0--------uhu----� �� (� _ �w � -------------•---------------•---- u. ntractor's Name ~�_ 1 _y-. ( 1=�- Phone Installation will serve: Residence ,� A�.rtment House El Commercial El �'T�railer Court ❑ Motel ❑ Other [I umber of living units: _�.._--- Number of bedrooms ___ Number of baths/ _t�Lot size ----- _____ _ _ _ ____________________________ Water Supply: Public system ❑ Comniunity�system ❑ Private ❑—Depth to Water Table ��a--- ft, Character of soil to a depth of 3 feet: Sand N--`Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (Hyes,date--------- -_:" ) No ©--New Construction: Yes D No ❑ FHA/VA: Yes E No El —TYPE,-OF.INSTALLATION--AND,•SP-ECIFICATIONS:_ " �, .--_"- .- �:-- - ��= -, -- -- "---r -�•� (No septic Tank or cesspool permitted if public sewer_is_available within 200 feet.) �. Septic Tank: Distance from nearest wA_, fes--A-Distance from foundation__r�__ ____Materia "�__� �Q� _ N _ x �X _Li uid de rth - - Capacity-----�'�---��--- - ----- ❑ No. of compartments________________________ Size__. a. ,. _ ___ _ q p. Disposal Field: Distance from nearest well_. �...Distance;from•Lfoundation----h6_1.....Distance to nearest lot line--- ____.---_- 0� Number of lines-----------2— --------------Length of each line__- ---+--_6--_.Width of trench------ r -------------------- i Yp r p tt # ig t 1 ------------- T e of filter material__.. ._�_[:.I�___De th of filter material________ _______ _____Total len th___---------_�_ N r— N dmber.of, its_-- _----..--:--_----Linin material----------------------Size:,Diameter------------------i---Depthst lot line----------------- ❑ nce to nearest well---------------- Distance from on------------- to Seepage e Pit: Dista Cess ool: Dista p g p Distance from nearest well-----------------Distance from foundatioL------._.-_--------.Lining mater-ial---------._.__..___.___.____,______. T-1 Size: Diameter--------------------- ---------------Depth----------------------------- ----..Liquid Capacity gals. Privy: Distance from nearest well_-----------------------------------------------Distance from nearest building---- --------------------------.----------- ❑ Distance to nearest lot line--- --------- - 1-t_4!------------------------------------ ----------- ---------- --------------- Remodeling and/or repairing (describe) ------ --------------------------------- ---------------------- - ------------------------------ -------------------------------------------- �1- -:5 L-7=; R-<.---------�f�---7�y.� _f ------ ufYFF --- ------ -- ------- - "- ; f'"hereby certify that I have prepared fhisapplication and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and reg lations of the San Joaquin Local Health District. --(Owner and/or Contr Signed �" /( f ��_.a-"y-�------- - ------- S actor) - 4y -------------- Y•-----------------------•-•----- ---"�- - ------------------------ ----------- ---------------------------- ----------- -(Title------ - ----------------- --- -------- ------- (Plot 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----�`.-F?!.0------------------------------ ---------------------------------------- DATE---------g_-- = ------------ 4 REVIEWEDBY--------------------------------------------- ---- ----------------------------- ------------------------------------- •--- DATE--------------------•--------------------------------------- BUILDING PERMIT ISSUED---------------- - - DATE--------------------------- --------- ---__....... ._, .. _a�_. . .. 1 Alterations and/or recommendations:------- ---------------------------- ------ "T " 1------------;---.--=-- --------- --------- -- ---------------•------------- ---------- ----- ------- N ---- c------ - --- - ------------------------------------------'-1'- ---- -------------�----------------------------------------------- --------------------------- _-------------------- -- -- ---------------- -------------------------------------- - ----- - - - - - - -- - - --------- - --- -------- ---- - -------- ---------------------- ------------------- ------------------- J ----------------- FINAL INSPECTION-8-Y- ----------- Date---. S - SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi, California Manteca, California Tracy, California F.P.0 O.