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F�7K OF--C.t USt: r ------------ APPLICATION- FOR SANITATION PERMIT Permit No. _fr�/._G--_-_-_-- E�/�" f�-' �� ------- (Complete in Duplicate) -------------- This Permit Expires 1 Year From Date Issued Date Issued _f_1-04__X" 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. .A4 G(:�rNL_g } f JOB ADQRE55 AND L TION---- --- �11.4/�- ---�; vrl� SP Grt--- --- a Owner's Name---------_f `` '�L10 Phone Address.---•-------•------------------------ --••-•-- - - Contractor's Name------------ ✓zf ''r Q� ----------------------------------------- ------ Phone----•--------... ��pp Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trail Court E] Motel E] Other Number of living units: --0---- Number of bedrooms/6 Number of baths ._ Lot size ---------------___________________________________________--- Water Supply: Public system ❑ Community systemrivate ❑ Depth to Water Tablec2_!d./ft. Character of soil to a depth of 3 feet: Sand ravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date--------- -------- -) No,F] New Construction: Yes g. o�] 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_.V_ Dist nce ion_ --- ---/______.Material_ No. of compartments--------------------------Siz -_«_' � Liquid depth----------- - ----------Capacity_6•y__.aV_____ Disposal Fi Distance from nearest well-%0... ._Distance from foundation----/__!----Distance to nearest to line--- Number of lines----------------- Length of each line-_.__---_._______-__----------Width of trench-j-.--.---------.--------------- Type of filter mate rial__1_I->----------__Depth of filter material__x�_----...___Total length--41�-,Yd?�---k___________________ Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line_.______-__-.._ ❑ Number of pits----------------------Lining material---------------.------.Size: Diameter-----------------------Depth----------_--------------------- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material_ __.____._._______---_.______.______ ❑ Size: Diameter--------------------------------------Depth-------- --------------------- - ---- --- ---------Luid Capacity-------------- -- --------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building--------------------------------- ---... ❑ Distance to nearest lot line ---- ------------------------- -------------------------------------------------------------------------------- Remodeling and/or repairing [describe]:. l ,Q• J. ,$1 �. --------------------------------------------------------------------------------------------- --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ---------- - ------------------------------- --------------------------------------------------------------------------------------------------------------------------------------------•----•------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin Count " ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed)-----------------/��------- -------- ____ _.___(Owner and/or Contractor) BY: L[/ (Title -------------------------------------------- (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 APPLICATION ACCEPTED BY--- - �-/ ,---------------------------------------------------------------- DATE---- ------------- REVIEVV'=D 'BY------------------------------------------ - - ---- ---------1__.__1--------------- ------------------------------------------ DATE BUILDING PERMIT ISSUED------------- ---- -------- ------------------------------------------------------------------------- DATE Alterations and/or recommendations:--__.?__f ;--cc °---Lr`` - /- --�3, '----� � `'� ------(1)_ V�-----ralj ol-----/---X --•----- ---------------I--------------------------------------------------------- ------ --------------------------------------------------------------------------------------------------- --------------------------------•--- --------------------------------------------------------- ----. -------------I------------------ ----------------------- ----------------- FINAL INSPECTION `-------------------- ----------------- lfl ----------- bate. SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California