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FOR OFFICE USE: APPLICATIOWFOI� SANITATION PERMIT Permit No. -'_"•Z- 4. o 1Comhsie`;e in Duplicate) pate Issued ____ ' �a------------------- -----". -! � I This Permit Ex iYes 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 Couqfyv Ordinance No. 544- JOB ADDRESS AND LOCATION-- G2 -h Owners Name------ ��- --------------------------------------------------- -- ------ - ------------' - -- ---------- Phone---------•-------------------------- a _._ r ------------ ---- Address----------- - �} - ------------ - - Contractor s Name_.__ _ Q`�_____ ----------- ----------------------------------- ------------- --- Phone- ---••------•---------------- Installation will serve: Residence ©�-`Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _/--- Number of bedrooms _.-3o/ Number of baths _ Lot size ________________.-------__._..-____. -- ------ ----- ---- --------- Water Supply: Public system Community system Private ❑ 'Depth to Water Table4��ft. I Character of soil to a depth of'3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Q_-Herdpan ❑ Previous Application Made: (if,yes,date:-._-- --------I No Q�New Construction: Yes la--�Nq;❑ FHA/VA: Yes 2R---No ❑ s � TYPE OF INSTALLATION AND SPECIFICATIONS: (No septiciank or cesspool permitted if public sewer is available within 200 feet.) 4 t it ;I s Septic Tank: I Distance from nearest well--.-'-— Distance from foundation__ _�._r----Material__0,13...Re��r�"®-- ------ - - ®�'� No. of compartments`----','* - -----------Size __ --Liquid depth----'--- -- ---------Capacity__ �_�? �-_-.-- Disposal Feld: Distance from nearest well-_-_—°__.._.Distance from foundation"_ e--/-""Dist1nce to nearest lot line._ __ j 00 - */----------------- -- ----- . Nunsber of;lines_,. _____________.._. length of each line_ Width of trench_ ____ �/ -Total len th---- `---------------------- 1. r Type of filter material__I�_,A Depth of filter material_"_. _ ______ } g f Seepage it: Dis an { t ` P ;,I t t Ge to nearest ell___- '--._______Distance from fa nda#ion__�5 .-----•.Dista tie• to nearest lot line.-_�_._"_____ I ;,.—Number of pits--�__ �----------Lining material-- -Size: DiametEr__��. Depth-��r___- l�u�'----• Cesspool: Distance from nearest well-----------------Distance from foundation.-----------------Lining material______________________________________ ❑ Size: Diameter''J- ----l'-------------------------Depth-----------;--------------:-- -----I-----------------Liquid Capacity------------------- gals. Privy: # Distance from„nearest well---------------__._----__.______"-------------Distant 6 from nearest building------ - ❑ Distance to nearest lot line----------------------------------'---------- - i� � I � I Remodeling and/or repairing (describe}:-. �' _ -' - ----------------------------- --------------- -------------------•- ------=------------------------------------------ t ----I----------------- --------------------------- ---- ----------------------------- ---- i 1 ----------------------- 7------------------------------ ----------------- -----------=------------ -------------------------------------------------- --------------- -- e prepared this application and that the work will be done in accordance with San Joaquin County 1 hereby certify that I hav ordinances, State laws, an rules and regula ibns'. of the San Joaquin Local Health District. A.. (Signed)_ -------------- - -- -- -- ------------------------------(Owner and/or Contractor) .Yl ay:. ----------------------------------------------------------' ( ' ) �� -' ._..... Ti+le (Plot plan, showing size of lot, location of system in relation t ells, buildings, etc., can be placed on reverse side). in: 4 FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-- ---------------------------- DATE------- �' ------------------ DATE---------------------------------------------- RIVIEWID BY--------------------------------' -- - ' ------------- BUILDING PERMIT ISSUED 7------------ ------- - " DATE ---- - ------ Alterations and/or recommends+i ns......... t -------- if ------ ' � � .� �,�' 1 -------------------------------------------------- ------------------- "--- I jf ---------------------- ------ x ------- ----------------- - --------- �------.-------'----•--------------•--------•------�-/-�------- -------------- ---------------------- --------------------- FINAL INSPECTION BY:. Date-- -'-'- 2 ----- ------------------------------ SAN ;F f JOAQUIN LOCAL HEALTH DISTRICT �.. r' triOt"E:Ho:elton Avg.`" 300 West Oak Street a X124 Sycamore Street `i lex 205 West 91h Street Stockton,California Lodi, California wT nn nteca;�CalifoTnia t t r Tracy,California F.P.C G.