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rUK UrrlC_r USt: ------------ - APPLICATION FOR SANITATION PERMIT Permit No. _-.�2.--131•_-- ---------------------- ---------------- --------------- (Complete in Duplicate) ff ..--- This Permit Expires I Year From Date Issued Date Issued -f -_- _-1�� 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--,T-/---,// .... Q/ - 1 A Owner's Name 4�K/-�- - Gf. S Phone._4_ �"71_ -_S Address.----- `S`--1- Contractor's Name---- ---------- --------------- Phone-------------------- Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other JO 'T-RI¢/ kl- Number of living units: J---- Number of bedrooms---_ Number of baths --I---- Lot size __ :_ ,5 -------------------•------- Water Supply: Public system ❑ Community system ❑ Private)< Depth to Water Tablet. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ # Previous Application Made: (if yes,date--------------------) No ] New Construction: Yes,' No ❑ FHA/VA: Yes ❑ No1 +�+ TYPE OF INSTALLATION AND SPECIFICATIONS: f (No septic tank or cesspool permitted if public sewer is available within 200 feet.) I Septic Tank: Distance from nearest well__--.---Distance from foundation--��.___ �� p No. of compartments---- - 1� ,K.� ---- ----------Size- - ,� --------Liquid depth----!!_/5-t------ -Capacity1kQ•�-',__-- Disposal Field: Distance from nearest well.--,3-0-_-_Distance from foundation------ ---(._---.Distance to nearest Igt line---6------_--- Number of lines---�r----- - ----------------Length of each line--_ t�__�_ Width of trench.---X____�__.-___.. Type of filter material-- _. Cf -._______Depth of filter material__/-q_____-----..Total length-----�Z�________-_ ---------•--•-- Seepage Pit: Distance to nearest well---------------------Distance from foundation--------------------Distance to nearest lot line----------------- El Number of pits-------------------_-Lining material------ -.-.-------- -- Size: Diameter----•-----------------Depth---------------------_ ------------- Cesspool: Distdnce Distance from nearest well-----------------Distance from foundation-------------------Lining material-------------------------_-----_ ❑ Size: Diameter- ------------------- ----------------Depth--------------------- ---------------- --- - -- -- -Liquid Capacity-- ---------- --------------gals.. Privy: Distance from nearest well,-------------- ------------------------------ ---Distance from nearest buildin ------------------------------------ n ❑ Distance to nearest lot line.- _--__-__- --------------------------------------------------------------------- Rema . g and or repairing (describe}:- -_-- -_ �-t�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 laws, and rules and regulations of the San Joaquin Local Health District. 1 (Signed)---- - �9 }- --•----- ------------------------------- -- � -------------- ----------- ------------- - -------------- --- - -(Owner and/or Contractor) r BY: - - Title r ( - (Plot plan, showing size of lot, location o ystem in relation towells, b ildings, efc., can be placed on reverse side). F211 DEPARTMENT USE ONLY APPLICATION ACCEPTED BY row' ------------- ---------------- ------------- DATE--- f - -� - REVIEWEDBY--------------------- -- ---------------- -• ------ --- ------ ----------------------- �-------------------- - DATE------------------------------------------------------------ - --- --- ------------------- ----- ------------------------------- BUILDING PERMIT ISSUED. - ---------------------------------------------------- - - -------- 1 DATE------ --------- Alterations and/or recommendations:- _ �._3Q_-- _ -- i-- �cs - �- -------------- - -f- 7` �..:-2-L� - �- �. - - ------- ----------------------------- ------ ----------------------------------------------------------------------------------I----------------- FINAL INSPECTION BY:. J..... -------------- Date-----, 77-3_-7.(O 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 F.P.CC.