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FOR OFFICE USE: :l _ � � �• �� ---------=----------------------------------------------- 'I APPLICATION FOR.,SANITATION PERMIT Permit No. 3.. ------------------------------------------- I - - --------------•-- ------------------------------ (Complete in Duplicate)--- - - -�------------I`-- -.. Date issued ---..------_---------- --------- This Permit Expires 1 Year From Date 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 incompliance wit County Ordinance No. 549. I1 9 ' da JOB ADDRESS AND LOCATION..___...__._.____ q....__ �- .._gi == ,t� = = -------- -'----- --------- --- Owner's Name- PhoneAddress----------•--- 1 --------024 -- ------------------ J��---•------- ----------------------------------------------•-----------•------------ Contractor's Name---------- .�------------ ZC5--ty-------- ! 5--- ....... Phone.:`A�?_&vq_007---- II ' t Installation will serve: Residence t�Apartment House ❑ Commercial ❑ Trailer Court E❑ Motel ❑ Other ❑ Number of living units: ____I_ Number of bedrooms __1- Number of baths ____�-_ Lot size ---------------�� i�G- ------------- -_- Water Supply: Public system ❑ Community system ❑ Private /Depth to Water Table -_Cr)ft. f Character of soil to a depth of-3 felt:- Sand'❑--Gravel ❑ Sandy Loam ❑. Clay Loam�[+Q�Clay ❑ Adobe ❑ Hardpan ❑ Previous Application -Madel: (If yes,-date--------------- .) No [�"—,New Construction: Yes ❑ No p HA/VA: Yes ❑ No ®.10 — TYPE OF INSTALLATION1, AND SPECIFICAI;TIONS: f (No septic tank or cesspool permitted if public sewer is available within 200 feet.1 9 q r Septic Tank: Ditakrice,-,from nearest well__._. ___.._Dis ante from foundation-----�j)-._-_---Material-_____-________________________________________ ❑ I No. ofpcompartments---------------------'-- Size =<_t ----------------------Liquid depth------------------------ -Capacity-•-------------------- Disposal Field: Distance from neares+`.well 4P___.�Distance4rom rfoundation.._�'©.._.__..Distance to nearest lot line_ _____.... . s Cr Number of lines-----/_-_- -_ Length of each�'line----- Q. ..____-_-___..Width of trench._o�?c._------------------- YP welld �� Depth of filter"mAerial__�_-_ _---------Total length-__./ �_-_P____________________ I! T e of filter maferlaL Seepage Pit: Distance to nearest _._..._-__.__ -___Distance from foundation_________________ Distance to nearest lot line.------------_-__ ❑ Number of pits------- r-----------Lining rmaterial------------------------Size: Diameter-----------------------Depth--------------------------------- I ,. p _ Distance from nearest well_.__. .____:..__Distance from foundati n,�------------- _ _____Lining material----___-.._..-- ...______..____..___ ❑ Size: � Cesspool: DDiameter - Depth -. `' - -----------._Liquid Capacity-------------._--------------gals. Privy: Distance from . earest well -------------------------------------------Distance from nearest building----------------- ------------ ❑ ce to nearest lot line.-- ------ -l-�------------ ------- --------------'--------------------------------------------------------------------------------- _ t-. Remodeling and/or repai ing (describe,;- --.�e�....... 'x/.�_%// G _ L. l ---------------------------- ----------------- --- ---------------C-••------------------------- _ ----- ie _ _____________________________ _ -------•-------------------------------------------- 1 hereby certify that I haveprepared +hisapplication and that the work will be-done in accordance with San Joaquin County ( I urn calf, District. d rules and r tuns of the San Joaq , ---------- �/�l� 91 ? ordinances, tae laws, an, (Signed) _ n�;;V � t � Own and/or Contractor By:------------- ---- i-------------------------------------------------------------------{Title} -f------ ------ ..... - ----------- -- (Plot plan, showing size of lot, Iocati of system in relation to wells, buildings, efc., can be placed on reverse side). h _ FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY-{--- ------- ---------------------........--------------------------- ------------------------ DATE------------------------------------------------------------ --------------------------------- DATE----- --------------- REVIEWED BY-------------------�'---------------------------- ------------------------------ --- ----------------------------------- BUILDINGPERMIT ISSUED-------}l--------------------- -- ------------------------------------------------------------------- DATE------ ----------------------------- ----------------------- Alterationsand/or recommendations----------------------------:----------------- --•-----------------------------•--------------•----------••---------------------------------------------- ------•--------------- ----------- ------`---------------•----------- ---------------- -- ---------------- �'----------------------------------------------- ----- --------------------------------------•----•---- ---------------------------------- -------- ----------------------------------------�;A__-kV IN-,------ ' r------------------------------------------------------------------------------- -- -------------•----------- ------------ ---------•-------------------------------------- AA f1 f FINAL INSPECTION BY--- -------- -------------- !Y' Date-----------------%---r_4�-� ------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Ha:eltan Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California II F.F.CC. II ' - II