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FO USE: e ---- -- .- _..... ---- ------------------ APPLICATION FOR SANITATION PERMIT Permit No. _ (Complete in Duplicate) / � t Date Issued ---/ bf--�`-S� ' ---------------- ----------------------- -------------- �� 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_- __ --- --- --- ---------L�,�yJ-,�r.-Qc.---------------------------------------------------------------------------------------------------- Owner's Name--------- " ------- Phone------------------------------------ Address ` ► -------- ----------------------- ----------------------•--•-------------------------------....... Contractor's Name---------------b R.G_eid� Phone Installation will serve: Residence [Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel [❑ Other ❑ Number of living units: ____j__ ; mber of bedrooms __2--,Number of baths _1_____ Lot size ____ O�___ Water Supply: Public system Community system ❑ Pr*vate [) Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand Q ,Gravel ❑ `Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe W-11'ardpan ❑ , Previous Application Made: (If yes,date----------- -- I No [j��New Construction: Yes ❑ No 59,-'�FIA/VA: Yes ❑ 'No TYPE OF INSTALLATION AND SPECIFICATIONS: I (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well-----------------Distance from foundation--------------------Material------------------- d 1571,4fk No. of compartments-------------------- -----Size-------------------------,,----Liquid d - epth---------- ----- --------Capacity--•------------------ Disposal Field: Distance from nearest well-----p"--------Distance from foundation-` 0.....-_-..Distance to nearest lot line__,57_/ �41,sfie• Number of lines-----`- ---'` - -: -----Length of each line-----�-J---------------Width of trench_.-4V.��----- ---- --------- l� Type of filter mate rial__/� ___ G.�Depth of filter material ___A_�_��______._Total length----v'�'� f------_-----------.--------- �J r Seepage P- . Distance to nearest;well------�^~---------.Distancer.£;om foundation____b►__'____.Distance to nearest lot fine_0 Number of pits--- -------_.,Lining material_AKI-----------Size: Diameter- - -- -- -----Depth--L , 'f y -------- Cesspool: Distance from nearest well_____---------- __Distance from foundation------------------..Lining material--------------._____.____. ----------- ❑ Size: Diameter---- #----------------------------Depth---------r--------------------- - - ----------------L+quid Capacity----------------------------gals. Privy: Distance from nearest well----------_---_____________._-_-------_----------Distance from nearest building____----________________--_---._____..._. ❑ 7 Distance to nearest lot line f p Remodeling and/or repairing (describe)________________ _ r I : -------------------••----------•---------------------------- - ------------------------------------------------------------------------------- ---------------------------------- - --------------------------i------------------------------------------------------------ ------------------------- ------------------------------------------------------------- ------------------------------------------------------•--------------- I hereby certify that 1 have preparedfMi-applicationonand-that fhe work will-b`edone-in accordance with San Joaquin County F ordinances, State laws,-and rules and regulations of the San Joaquin Local Health District. f (Signed)--------------- Zjolation e. � -- ----- -------------------------------------------- --------------- ---------- ...............(Owner and/or Contractor)By:--------------------- Title----- ---------------------------------------------------{ )----. J��-►rte.._....._...---- --- - ------- (Plot plan, showing size of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY r APPLICATION ACCEPTED BY--- • .... f` r - DATE ------------------------------- REVIEWED BY ----- ------- ----------- ------------------------ DATE--- ----------- E UILDING PERMIT ISSUED-_. r-�-= D TE------------------------------------- ---------------------- Alterations and/or recommendations:-_ /�.��----- ,r p•� ___-d`r��/ ----------------------------------- ---------------- ------------------------------------ ----------- 1 -------------------------------------------------------- -------------- FINAL INSPECTION $Y:_ --- ---------------- Date...... ------ - ------------------------------•---- I 1 SAN JOAQUIN LOCAL HEALTH DISTRICT d w � 1601 E.Hazelton Ave. "�" ;} 300.West Oak Street 3 124 Sycamore Street I - t, , r �_ 205 West 9th Street Stockton,California Lodi, California Manteca,California Tracy,California F.P.C❑.