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FOR OFFICE USE: '- . ` .w. .rte t------ -- --- ,r Permit 7 No. _cam/ Y- __ _ APP�.ICATION FOR SANITATION PERMIT -------- -- ----------- - (Complete in Duplicate) Date Issued _-"--- -_ 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 L ANON ID a�Q-------- 1�"�1 --------sr 'A �� ------------------- -- - R EA_4 ------ Ph .-----�--------- pp-------•--- Owner's Name-------------- ------- ,- one ..8 Address `.3-9-7--- .! '_ •----------�°------• TIE -j - C r , - Contractor's- Name----- '-------------1------ -------- ------'---------•------- -------------------------- Phone Installation will serve: ResidenceApartment House ❑ Commercial ❑ Tr 'ler Court [I Motel ❑ Other C] ` . Number of living units: _.�-__t Number of bedrooms -"" Number of baths _ ____ Lot size p .0- ft. Water Supply: Public system ❑ Community'system ❑ Private �De th to Water Table Character of soil to a depth of 3 feet: Sand Gravel [ISandy Loam ❑ Clay Loam E] Clay ❑ Adobe E] Hardpan ❑ I No N Previous Application Made: (If yes,date--_-- ....,_ ) No New Construction: Yes ❑ FHA o /VA: Yes ❑ �— TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 204 feet.) _ .,�. '"-'"�"�`Septic`Tank:: ` Distance"from newest'Ore"I1. ._...__-_.__-_Distance-from4oundation--�__� .Matena_- �X"�- '6 PJC- No. of compartments-_____._ -------- -------- -.._ Size--------------------------------Liquid depth--------------------------Capacity--- ----- ---- - Disposal Field: Distance from nearest well__.,.?.r4�__.:Distance from foundation----/O_P-------Distance to nearest lot lira --------------_-- r -__ .____ ___-- � A{ Number of lines------------ --------------- ---Length of each line-------5_ .-�+-----Width of trench------- [.---- -----y----- C� ------ Seepage - Total length----------------------=� --------- Iq V A Type of,filter material__ _ Q. --""Depth of filter material_..._ See a e Pit: Distance to nearest well--___-----__-----___Distance from foundation--------------------Distance to nearest lot line___.-___________ p g ❑ number of pits--=[-----------------Lining material------------- --------.Size: Diameter-----------------------Depth--------- -------- --- ---- Cesspool: Distance from nearest well-________________Distance from foundation---------- ---------Lining material____-.-____-.--------------------- ❑ Size: Diameter--- -------------------- ---------Depth---------------------------------- --------------- Liquid Capacity... -----9 4. Privy: Distance from nearest well________________-___----------------------------Distance from nearest building------------------------------------------ ❑ Distance to nearest lot line---------------------- �� f ' Remodeling and/or repairing (describe):------------------------------------------------•--------------------^------------------------------------------------------ ---------------------------- t ---------------------------------------- ------- ------ ---- ----------------------------------------------------- ------------------------------------------------------------------------------------------- I hereby certify that I have prep ared----------------------------------------------------------------------------------------------------------------- y y p .pared this application and that the work will be done in accordance with San Joaquin County I ordinances, St to laws, an ules and regulations of the San Joaquin Local Health District. (Owner and/or Contractor) (Signed)-- -- By:--------------------- Title l= (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY --------:- -- i APPLICATION ACCEPTED BY - -« ------------------- ------------------- ---------------- DATE---- ---------- � --------------- --------------- REVIEWEDBY-------------------------------- ----------------- --------------------- -----------------• DATE------------------------------------------ ----------------- BUILDING PERMIT ISSUED------------ --- -- DATE - ---------------- Alterations and/or recommend ations:_-_-------------- " '----^------F'----- -- --- ---------- --- --------------------------------------------------------- ------------ ------------------------------- - ----------------------- ---------- --------- ----- ------- ------•------' - -------------- ---------- - ------------ - -- --- ------- _ - ------------- + ' Date--- j ----------------- )Z__ FINAL INSPECTION Date-- ,SAN JOAQUIN LOCAL HEALTH DISTRICT 4 1601 E.Haxelion Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street 1 Stockton,California l Lodi,California A Man+eco,California Tracy,California F s F.P.CO. - r .