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FOR OFFICE USE: � --- G------ --- ---------------------- / 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 per it to construct and install fhe work herein described d� This application is made in compliance with County Ordinance No. 549. , It - lid JOB ADDRESS AND LOCATION--11e ,�- . -0 ------------ r Owner's Name---- A' x`1!:-0. 0............. ------ j ePhone-----•----/-----`--- ------••-•-------- - --------•------•--- Address-------------- Z_417.......A.,----- �Zgll' - + -.... --- ------ - -----------• Phone__Contractor's Name-------- -h. --- � ,,574 Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: j,/---- Number of bedrooms 1� Number of baths __/__ Lot size ---rr_-�-Q_r__)c----_----�•-------- Water Supply: Public system C] Community system El Private RR-- pth to Water Table alrft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobeardpan ❑ Previous Application Made: (If yes,date_- ------------) No ❑ New Construction: Yes ❑ No U?"IFHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) 00 Septic Tank: Distance from nearest weILO_.___.Distance from fours tion--. Mate ial-- F; __________________ �Q No. of compartments.'__...-.-. ___ ---Size_wl!_��f iquid depth-�' ��___--..Capacity-f " Disposal Field: Distance from nearest welt± Q______Distance from foundation j-0._--..----.Distance to nearest lot line.---�----- Number of lines_____ _.__.`-------------Length of each line%��s�_+6��- Width of trench- ------------------- Type _--.---..---.---. T e of filter material _De th of filter material----./. Total length----------.�j6_Q_'e------------- Z YP p ,� � ------- Seepage Pit: Distance to nearest well_____________________Distance from 'foundation----------..--------Distance to nearest lot line-----_..--------- ❑ Number of pits-_-------------------Lining material-----------------------Size- Diameter---------.-------------Depth----...------------------------._ Cesspool: Distance from nearest well-------- ------Distance from foundation--------------------Lining material-._.____.____.__-_-------.------------9 ❑ Size: Diameter--------------------------------------Depth--------------------r----------- -------- .-------Liquid Capacity- --------------------------gals. Privy: Distance from nearest well----------------____---------------------_- -----Distance from nearest building_._..____--------------_-_____---- ❑ Distance to nearest lot line ------ -------------------------------------- -------------•----------------------------------------------------- -------------------------- Remodeling and/or repairing (describe):--------------------- �----------- •---- ---------- - -------- ------------------ 11---------------------------------------------------------------- , ---------------------------------------- -------------•--•------------------------------------------------------------------------------------------------------------------------------------------- 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 andregulationsof the San Joaquin Local Health District. a (Signed} ZAY - r-- ¢ � --?etc ----- ---------------- Contractor) By:------------------------------------------------------------------------------------------------------- ------- --- - ----------- --- --------- ... . .------------ (Plot plan, showing size of lot, location of system in relation to wells, ildings, 7_,'nq6e6p=don reverse side}. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----- i. -------------------------------------------------------------------------- DATE---,-' - �� --------------- - t REVIEWEDBY------------------------ -------------------------- -------------- ------------ ----------------- -------- ----------------- DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED------•---------------------- -----------------------------------------------------------------_;--- DATE---------------------------------- --------------------- --- Alterations and/or recommendations:--------�1.__'.�-�---------------- -----------------------------•----- -------------------------------------------------------------------------------------------------------------------------------------------------------- �(Q 5 , ------------- ---------- -----•------------ ------------------------------ ---- ------ I ------------•--------------•------------ -------- -------------------------- --------------------------- ----------------------- --------------------- ---------------------------------- --------------------------------- 4 - ----- ----------------------- -•---------------------------- ------------------- -•---------------------- FINAL INSPECTION BY:------ --�- ---- `-� -- ------------------- - Date. �-'..�_�� - �0'°r 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 r.a.c o.