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FOR OFFICE USE: Lit - -------------------- - --------------- Permit No..foZ�we�3 I APPLICATION FOR SANITATION PERMIT -- ---------- -------- ......... -----•------•-•. -- -- (Complete in Duplicate)Date'lssued --------- — -------- ....... -------- - ............. This Permit Expires I Year From Date Issued Application is hereby made to the Son 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 -------- 3,2-7.1. .................... --------------------------------------- 7" Owner's Name.... _�:PR ....... ---------- .............. _4F // / Address. -•--•---------r.5 3.,2 ..... ... ZAI .. ......... -------------------------------------------------------------------------------------- - f Contractor's Name... .... ------ ............... Phone_44:61k-.9.A-a_7 Installation will serve: Residence [9 Apartment House 0 CommercialE❑ Trailer Court 1Motel ❑ 0 0ther 0 Number of living units: ../JNumber of bedrooms r Number of baths Lot size ._�-S ............. Water Supply. Public:system E] Community system 0 Private EK Depth to Water Table 4,$' ft. �-d Character of soil to . lepth of 3 feet: Sand ❑ Gravel Sandy Loam [] Clay Lo'a m 9 Clay 0 Adobe [I Hardpan El Previous Application Made: (If yes,date ------------ N6 JR New Construction: Yes ❑ No _Pq FHA/VA: Yes E] NOR TYPE OF INSTALLATION AND SPECIFICATIONS. (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from. earesf well ------------------ Distance from foundation ------------------ _Material ............................................ ' n op F -I No. of compartments -------------------------- Size_.... ............. _ ---------- Liquid d& th .................... ------ Capacity ------------- ......... Disposal Field: Distance from nearest well ----------------- Distance from foundafion__ ---_------------- Distance to nearest lot line....._.._.. .......... .... .... i� Number of lines J -------- Length of eacb Iine,,w-&0). --- I -------------- Width of trench.- ...... A ....... m Type of filteraterial. Depth of filter a'ferlal .... --------- Total length__...____? --- -- - ---------- 7 1i Seepage Pit: Distance to nearest well.. 3.'...._.Distance Distance f5orn fou'ndation.zl� ------ _ Distance nce to nearest lot line ... ..... kp Number of pits.._., ......... ----Lining material Size: Diameter_'& ............ Depth ... oZ.5 ------- ............. rk Cesspool: Distance from nearest well__ .-_-...__Distance from foundation ....................Lining material ...... __ --------------- i__ ........ _t7 ❑ Size. Diameter ------• ------------------------------ Dept h ----- ------- --------------------------------------- Liquid Capacity ---------------------------- qals, Privy: Distance from 'nearest well_________________________ ........ .-.-___...._Distance from nearest buildings__.....-.-_._.-.--__--___ ."o _ ... ....... Distanceto nearest lot line...._-----------..... - ---------------------------------------"---------------- ---------------------------- ---------- ............ .. 00 Remodeling and/or repairing (describe):. ------------------ ------- .................................................. ...... ......... ----------------------- ------------ ......... ��n ------- -------------- 4- -------- I..__ ........ --------- ------------- ................ 4 - N i I .......... .................... .... .................................................................. ._.____/ ---------- I ----------------------- ------- .......... I .................................... .................................... -------------------i. ------------------------------------------------- ___ --------------- ......N -------------------------------- Jtj�' -------------------------------------------- I hereby certify that I have prepared this application and fhatt the work will , be done in accordance with San Joaquin County .0.1 ordinances, State laws, and rules and regulations of the San Job LocalHealih'D , isfrict. ' 1'1' % -4 �.:OjOjner and/or (Sig ned)_.__.zr-De._ . ......... Contractor) - By: _.....--• ------- ---- - -- ------------- -- .. ............ / ......... (Tif ------- _- --------..._-. [Plot plan, showing ------- -- to ion of system in relatio--/ ------------- ng size of lot, lo n �. wells,'$uildings(efc., CaA,15e placed on reverse side).' ey- FOR DEPARTMENT USE ONLY V APPLICATION ACCEPTED BY..... --- - ------- ----------I------------- _-_ DATE---- -------- ------------------------- PEVIEWED BY----- .............. ----- ------ ----------------- ........ ------- -------------- ------- I .......... .. __ ... DATE..... ----------- ........ - ---------------- BUILDING PERMIT ISSUED.-------- ........... ------- --1 ------- DATE .. ..... ........................ ------ .................. L__ P. -t. a .................. ------------- ............... .. . : ---------_------ Alferaflons and/or, recommendatio ns:-, ..... .. --------- - .................................. -------------------------- --------------- ------ ----------- ............ -------------- ...... ............ ---....-----•-•--•------ .----•-----------....... .................................................. I ............ __ ........ ---•-------------- .......------.....ti.. ------------ ............. ------------- .. ................................... ........... .... ............ ........ ................. ............. ................. --------- ---_------------------ ----------------------------- ----- ----------- ------------------ .......... ...................... . ................... . ............. ------------ ....... -------------------- -------------------- ..... ........... -------------- FINAL INSPECTION BY: -----...61` 0 ................ ................ Date------. . 4111 -- - -- ----------- ---------_------ - ----- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E. Hexellon Avo. 300 West Oak Street 124 Sycamore street 205 West 9th Street Stockton, Collfornia Lodi, California Manteca, California Tracy, California F.P.Ca.