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FOR OFFICE USE: --------- - ---------------- ------------------ APPLICATION FOR,�SANITATION PERMIT Permit No. ------- ------------------------------ ------ ----------- _. - ------------------- ,- - (Complete in Duplicate) t 47 Date Issued --'--..-.------ _ _------------------------- This Permit Expires 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 Ordinance No. 549. -------------- JOB ADDRESS AND LOCATION----------------------------------- y / - -------------------------------- 7� Owner's Name-------F i �s�QO ------ ------• ------------------------------------- --------- =---- --- Phone------- ------------------------ Address ..��--/--.•-•--------_��Tir�,�- �'y -;..---------------------------------------- Contractor's Name------------------------------ ------------------------------------- I--------------------------------- Phone-sal' ? Installation serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer [Motel [3 Other ❑ Number of living units: -__f--- Number of bedrooms J---- Number of baths ./--- Lot size -- .--. Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table .9-_ ft. Character of soil to a depth of 3 feet: Sand Gravel ❑ Sandy Loam ElClay Loam ❑ Clay ❑ Adobe ❑ Hardpan [I Previous Application Made: (If yes,date---------------------) No-4 New Construction: Yes Or No FHA/VA: Yes © t: No ❑ r TYPE'OF INSTALLATION�AN(SPECIFICATIONS: (No septic tank or cesspool permit#ed if public sewer is available within 200 feet.) � �c - ----- Septic Tan Distance from nearest well-64---_--Distance from om foundation--. -..-__-.Materially--:._- -_--- No. of compartments-. ._. Size - __ --j--Liquid depth--. _ .. _ Capaci# _ /!g-_ --- ----------- Disposal Field: Distance from nearest well6_0...-__-_Distance from foundation-/�-----._-.Distance to nearest lotor Number of lines-----------1------------ --------Length of each line---. ,----Pr------.Width of trench... V------------------- -- Type of filter materia CA2C/j'--Depth of filter material- __"_.�__--Total length ------------------------------ Seepage Pit: Distance to nearest'well__ e_i--.._----_Distance from foundation-/_5_..___..Dista ce to nearest lot line---_..- s� �� Number of its------- `` -Linin material t~ et ize: Diameter. .-- -_.�..- ep, /f------------------------- N P ! g 4V _ f Cesspool: Distance from nearest well___-------------Distance from fcundation-_.----------------Lininq rrztbteral____...-----__-------.------_----.--_. ❑ Size: Diameter--------------------- " ------------Depth--,------ -. ------------------ ----------------------Liquid Capacity---------------------------gals. , Privy: Distance from nearest well------------------------- ---- 4 = g ---------------------- . Qis�1 ance from nearest building Distance to nearest lot line---------------------------------------------- ----------•-------------------- t El Remodeling and/or repairing (describe}:--_.A��---��r��•--------- � �� '��fhC - ��'�`� - , i r -`" �------- a E Q ----A-Re - r�"fA_Aj-i------------------------------ ' ---------------------- - - ------------ � A =--- Off=----- A� ...--L�nj- ----- ------- --- --- I I hereby certify that ave prepared this application and that the work will be done in accordance with San Joaquin County I ordinances, State la d r4lts and regulations of the San Joaquin Local Health District. ` -------------------(Owner and/or - --- ----- ---- - �:.,.v..w. g... _ . - --------------------------------------------_ �. --------------(Tif le)----- --- - -- ..--.--- (Plot plan, showing size o ot, location of system in relation to wells, buildings, etc., can be placed on reverse side). pp FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED --------- --------------- DATE----- " '7�- -------- REVIEWEDBY------------------------- ------- -- DATE------------------------------------------------------ BUILDINGPERMIT ISSUED----------------------------------------------------._- "� ---------- DATE----------------- ---------- ------------------------------ t Alterations and/or recommendations:-------------- ----- ---------------------------------------------------•---------------------------------------=------------- ------------- ---------------------------------------------------•------------------- i - -----------------------------------------------------------------•---------------_-----•---------------.--------- --------------- -------- "_- 1 -- -------------i- ---- ------------------J--/-/-{-J---- ----_-------- -- ------------------------------------------------------ - ---- -------------- -------------------------------------------- ----- •-•--__-•-•--- ---------------------------- -- ------------ -------- --------------- FINAL �__-•• FINAL INSPECT- . .. ----- Date-------- .•_.. ------------- -- ------------------------ -- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haxelton Ave. A y 300 West Oak Street 124 Sycamore Street .205 West 9th Street Stockton,California. .Lodi, California Manteca,California Tracy,California