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FOR OFFICE USE: „ ______________ ._.. ------- APPLICATION•-FOR `SANITATION PERMIT Permit No. A&.0-49.1:9 (Complete in Duplicate) / ------ - _-- This Permit Expires 1 Year From Date Issued Date Issued f 7__1� =__(/a.a /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.--- Owner's Name--------- 1�-_ Ili Phone Address. �1f .1 ' .L�f1,S-----... , i1 . � 4[�i1✓--•------------------------------------------------------------ - Contractor's Nanie-------- /��IS�._ 27' Installation will serve: Residence Apartment House Commercial r-0 � p ❑ µ ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _-�---_ Number of bedrooms ---'--.Number of baths _l-.... Lot size ..... Water Supply: Public system X Community system ❑ Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam [-)3•Clay Loam X Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date_________ _________J 'No (, New Construction:, Yes ❑ NoX +HA/VA: Yes ❑ No.W TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) !i Septic Tank: Distance from nearest well_________________Distance from foundation-------------------- . y s "� -- ------- ------------•---------- ❑ .6X15,'11V,6No. of compartments------------------------------Size----a31�.5 J(_.�•-_-,_--Liquid depth-----�.�------- ------Capacity----- r��r�r� l Disposal Field: Distance from nearest weft-----------------Distance from foundation--------------------Distance to nearest lot line----------------- E] :___-_-----__-- a ❑ 4_MST1,rV Number of lines-----------------------------------Length of each line----------------------.------.Width of trench--------------------------------•-- �] Type of filter material----------- _Depth of filter material----------------------- length--------._.--------.--_--_.-_-_----.----__ v" f Distance to nearest lot line__. r 5eeprl'it: Distance to nearest well--- a2P�___Distance fr m foundation___ --------. ---------- W EV Number ofpits------ __ or -------------Lining materials / rt`'----Size: Diameter_ 3y. ----Depth__.._ '_________________ bi Cesspool: Distance from nearest well-----------------Distance from foundation__------------------Lining material--.-..._-______-.--..-__.____ ❑ Size: Diameter-•---- -------- -- Depth--------- -------------- ---------------------------Liquid Capacity -------- -----gals. .�.: — _- --.r Privy: Distance from nearest well--_______------------------ ----______._.._..Distance from nearest building_----------. --__--_---_-__-__-_----. .� ❑ Distance to nearest lot line---------- ---------- - - RemodE:ling and/or repairing (describe):__ i+ ..___ `_!S�//tom(-r _ J�iQ/,!✓_ -_ --------- -----------------------------= ------- -------- ----------- 3 ------------------------------------ --------------------------- ------------------------------------------------- -------------------------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Statelaws, and rules and regulations of the $ Joaquin^Local Health District. (Signed)----------+,11.- r /`� 1•StJrQX,S�_.__�LRC wne and/or Contractor) 10101 By:------ ----- ------70f - --------------- (Title) (Plot plan, showing sizeot, loc n of system in relation to wells, buildings, etc., can be placed on reverse side). I FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----- ------ --------------------------- ---------------------------------------- DATE.------------- ------------- - REVIEWEDBY------------- '---------------------- ------- ------------------------------ :-------------- --------------------------------- DATE-------- -------------------------------------------------- BUILDINGPERMIT ISSUED------------------------------------------- ----------------- ---------------------------------- DATE...------ ------- ------------------------------------------- Alter tions and/o recommen tion :_............... ------------- - . :__:::::____ ::-__ _:_ ---------------------- s ; -�.-.----- ----------------- ------------------ ----------... -------- -------------------------- - -- ------------------------------------------------------------------------------------------------------- - ---------------------- ------------ le` FINAL INSPECTION BY------------- ( _- C:a.----------------- --------------- Date..............Z�� SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Ho:elton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.Cd.