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F FOR OFFICE USE- 21. Ute- _ .s• -F a. � 3v -0------------- - - ti# ___ APPLICATION FOIL SANITATION PERMIT Permit No. _f --=-�= � . fete in Duplicate) Com Date Issued- ( _ 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. I "" --------------- JOB AUDRES7 D LOCATION "!---�1�-- P �f' ---------------------- Owner's Name---- - - "?'17 --------- ------ ----------------------------------- ----------- --- ------ Phone------------------------------------ Address3--V$ .-- 1�� .e.��-.E-10---------------- ----------------------------------------------- ------------------------------- 11 Contractor's Name--------------------- /29.._._ _-------------------------------------------z------------------- Phone..----._------------------------- Installation will serve: Residence Apartment House.❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ t Number of living units: __/-- Number of bedrooms S_ Number of baths a2 ----- Lot size _A_-:__4?40,0----.�A- -----<..�-!•--vim- -- Water Supply: Public system ❑ Community system g?"Private ❑ Depth to Water Table -_xbAt" i 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 22, -New Construction: Yes [P--�No ❑ FHA/VA: Yes ®►-No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ` a Septic Tank: Distance from nearest well/&&___Distance from f �nddation__L�✓____._.Mate�a�l-�f�-G�!�•�'�______________ Size�t. l' sem -Liquid depth---- �--------- p Y-- _ No. of compartments___p _.._______- Ca acit �Z �_. yle de Disposal Field: Distance from nearest wellistance from foundation__,e0*0'AP-------.Distance to nearest lot line_ kNumber of lines----- ---------.----------------Length of each line__.10;11z,`1-------------------Width of treach-- -- ------------------------ Type of filter material,� f� 'Depth of filter material_-_ �/.__-Total e-' Width ` Seepage Pit: Distance to nearest well__-!__t!_ Distance=from foun ation_ _ Q_________. Distance to nearest lot line-A/0___-__..._ Number of pits.__-----------Lining material-__ � Size: Diameter__s.."_ Depth.;? Cesspool. Distance from nearest well___--_____________Distance from foundation------------------- Lining material-------------------_.._____.______-_._. l ❑ Size: Diameter =`"� '----.Depth` ---------- --------------- - - -------------Liquid Cap�acitY Is. r 4 � i. _ ., . ...�.�..R........-._..,t; f I Privy: Distance from nearest well___----__------------------------_----------------Distance from nearest buildin•g-.-._...______.______________.__..____-. A ❑ Distance to nearest lot line_________________ ___ i - --------------------------------------------- Remodeling and/or repairing (describe):------------ ��- >v ,, • r St'lr�i� ------------ ------------------• �. --------------------------------------------------------------------------------------------------------------------------- --- f ----------------------------------------------- -- ---- -------------------------------------- ------------------------------------------------------------------- ------------------------- ---------- l j 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. -Q-/ L� �reliation ----------------------- -( r Contractor).,.-^'`,B '-------- ----------- ----Ism--- '------ -----(Title) G -�-Y '(Plot plan,-showing size of lot, location of sysfe to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY-------------- ------ -------------- ----------- ------------------------------------------------ DATE----------6 ?-- . . ------------------------- REVIEWEDBY!.----------- ------------------------------- --------------------------------------- ---------------------------------- ----- DATE-------- •------ - y -BUILDING PERMIT ISSUED------------------------- ----------------------- ---------------- ---- -------• DATE----------------- -------------------------- I ._Alterations and/or recommendations:_- �' ----1 - ------ ='_' -- -•--------------- { ------------------------------ ------ --------------------------------- - ----------------------- --------------------------------------------------------------- ----- - ----------------- ------------ - -- ---------------------- ------------------------- -------- r / / 1 FINAL INSPECTION BY:......_YE U✓---------------- Date---.--------- ---. �_ . .� y------------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 1160114.Hazollon Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Lodi,California ► '-Mantecci,California r zTraCy,'Califarnih t. Stockton,California - _ = r t �r