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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT !" Permit No. .-_� `.--�..... --------------------------------------------------------- ,, (Complete in Duplicate) r/ / --------------------------- ------ ---------- This Permit Expires 1 Year From Date issued Date Issued ---1 .-�y Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein descried. This application is made in compliance with County Ordinance No. 549. JOBADDRESS AND OCATION Q 3 _C_1-1) __. :--------------------------------------------------------------------------------------- Owner's Name-------- ------- Q" t#----! `� f- ?g 3�5------------------------------------- Phone.---------------------------------- Address---_----------------- �� '"� �C�------1-�=�` ----------------------•-----------------------•----••-•--------------•-••--•------ j Contractor's Name-----i_3 0 -------------------------------------------------------- ------ Phone----------------------------------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ----L Number of bedrooms a-)-- Number of baths --r---- Lot size _Lf�__.--)(,.1---------------------------- Water Supply: Public system ❑ Community system ❑ Private M-"Depth to Water Table Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay p Adobe lardpan ❑ Previous Application Made: (If yes,date----- --------------) No 2/'New Construction: Yes VNo HA/VA: Yes 2�/o ❑ TYPE OF INSTALLATION`AND SPECIFICATIONS: (No septic +ank,or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest we1l--.;5V__/__Distance from foundation--- - -----------M tenial--Lir �.�---_--�a�Q No. of compartments------�.--------------5i; z- +<? _ -------Liquid depth----- /Z---------Capacity-- -__-_----Ideo Disposal F' id: Distance from nearest well...S_Q/---Distance from foundation---f?.....----.Distance to nearest lot line---6__j------ Number of lines------�--J---------------------Length of each line-- -`"�F/0_2 Wid .7--11-.-----------.th of trench---�- Type of filter material----- - .�I�l2C. e th of filter material--- It _-..Total length__ -640_1-------- _________________ 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_---------------------.-_-_.------ ❑ Size: Diameter-------------------------- -----------Depth------------------------------- --------------------Liquid Capacity----------------------------gals. 17 Privy: Distance from nearest well-----------------------------_-------------------Distance from nearest building------------------------------_---------_- [� Distance to nearest lot line-- --- ----------------------- ------------------------------------------------------------------------------------------------- ------------ �. Remodeling and/or. repairing (describe: y: ,G -- r��•J `�� ----- _.._ P --------------------------------------------------------------------------------------------I--------------•------------------------------------;------------------------------------------------------------------------ -------- -------------------------- ----------------------------------------------------------------------------------------.----------:--------------------------------------------------------------------- - ------------- 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 and regulations of the San Joaquin Local Health District. ---___.-.-.Owner and/or Contractor Si ned A� � � '' ( / ) ( g )----- -------- (Plot plan, showing i of to , location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -_B.... --------------- ----------------------------------------------------------- DATE---- REVIEWEDBY.------------------------------- ------------ --------------------- -------- ------------------------------------------------- DATE----- PERMITISSUED-----------------_----------------------------- _ --- ATE------------------------------------------------------------- Alterations and/or recommendations:----------- f�� 4_'`. ------------ ------------------------- - --------------------------------------------- ------------------- ------------------------------- --------•----\------------------------------------------------------------- ---- ---------------------------- ------------------------------ t p --- ------------------------------' --- -- ------------------------- - - - ------------------ --------------- ---------------------------------------------------- ------------------------ ------ ------------------------------ -------- FINAL INSPECTION BY:- ---"Z----------------- Date---....�� l g �r� '��----------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hoxelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy, California F.P.0 O.