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F OFFICE USE: _/-..�. ----------------�7---- __t-- -- -- --- -- ----- APPLICATION FOR SANITATION PERMIT Permit No. .__ �2_-�J_ ------ ------ -- ----------- -- --- --------------------- (Complete in Duplicate) Date Issued .__yk��.�5 __________________________________..--.__ --------- 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 .WATION------ --c-5 ``— --------�-+�------ ------------------------------------------------------------------------ Owner's Name---------- f / 15---- -.2/ phone----� Address-----------------------_ == ---------------- Lam----------------------------- Contractor's Name ,�3 �------------------------------------------- --------------------------- Phone k y Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: --- Number of bedrooms - Number of baths /------ Lot size __ _0-------xa-� ________________________ ± Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table+R_7_ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam [❑ Clay Loam ❑ Clay ❑ Adobe "Hardpan ❑ Previous.Applicafion Made: (If yes,date---:................) No [ New Construction: Yes &4--No ❑ FHA/VA: Yes ❑ No ©� TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank-or cesspool permitted if-public sewer-is-available-Within 200 feet.) Septic Tank: Distance from nearest well----Y------Distance from foundation_-�,1.4-___------- ----- Material _ Ca-CJ-- --- - -- No. of compartments-------- - -------4��rt- _ Z—_7 __.Liquid depth__-__2j.!I�t---------Capacity---0�e___-_------ Disposal Field: Distance from nearest well.__+-------Distance from f©undation---1d__t____.Distance to nearest lot line___-/..... 0' Number of lines-------------� Length of each 11ne-------��_.a_-------------Width of trench------ j--------- ---- Type of filter material---I1-x...__...........Depth of filter material___ -------Total length___°-- _40 - l o ! �`---- 6 Seepage st: *Distance to nearest w II____'" ------------ m foundation_____ ____ _______ Distance to nearest lot line------------------ Number _____ Nurrrber of pits._______.__.______Lining material__- _ ' s sh Size: Diameter----------- - -- --Depth---+ _r ._- 1 # Cesspool., '° -. Distance from nearest well-------------- __Distance from foundation....------------._..Lining material----.--------------------------------- ___gals, ❑ Size: Diameter--------------------------------------Depth---------- ------------------------- _____________Liquid Capacity------------------ - 5 Privy: ___._Distance from nearest building-_ Priv Distance from nearest weft___________________________________________ ----------------- -._. , ❑ Distance to nearest lot line--- ------ ----------- --------------"---------------------------------------------------------------------------------- ------------- Remodeling and/or repairing (describe):---- } V �C. ----------------------------- ---------•----•------------------------------------------------------------------------------------------------------------- --------------------------------------------------------------------------------------------------------------------------------------------------------•----------------------------------------------------------------- -- ------------------------------------ -_____________________________________ --__-_____--.--______,-_-_____--_________-____________________________---___- __.______-_________________________________._____________________-________--__-----__.--__-_-------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State)455 and rules and regulations of the San Joaquin'Local Health District. �I (Signed)-----------a- - lj' - ------------------------ ----(Owner an or Contractor) e - ��-y {Title) - � ------- ------- �- �= - �-� [Plot plan, showing six lot, location of system in relation to wells, buildings, etc., can be placed on reverse side).7 ; FOR DEPARTMENT USE ONLY i APPLICATION ACCEPTED BY.......... ___-___-- DATE------- S ---------------- -- REVIEWEDBY----------------------------------------------------------------------------------------------------------------- ------------ DATE---- - ---------------------------------•------------"------ BUILDINGPERMIT ISSUED-------------- ------------------------------------------------ -------------------------------------- DATE.- ----------------------------------------- ------- Alterations and/or recom en ations:---------------------------------------------------- -- -- ------- ---- --------------- ----------------------- --------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- I FINAL INSPECTION BY:,.,, --------- VJOAQUIN Date- _ ' ySA LOCAL HEALTH DISTRICT 1601 E.Haietton,Ave. 300 treet 124 Sycamore Street 205 West 9th Street Stockton,California M1 Lodi,California Manteca, California Tracy,California F.P.Co.