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FOR OFFICE USE: --- --------------It.-_ APPLICATION FOR SANITATION PERMIT Permit No. 4,2 , e____- (Complete in Duplicate) -- ---- -- - ------------------- ----------- -- Date Issued -,-____"--------------------____-----_-___-_-_-._ .;__ This Permit Expires 1 Year From Date issued �te Issued d Fl �,L Application is hereby madelo the San Joaquin Local Health District for a permit to construct nd - s71; the work rein descrb This application is made.,in ctmpliance.with.,Cgunty Ordinance No. 549- s�6d/f� 15LIl-g JOB ADDRESS AND LOC�AATION_-5_��1 �.�_L/1--��---�`��F' f� - 44 -/ Owner's NameJ�z' +�--.4r( 1/S 1°+ I __ _---_-- Phone l 2`r .. ..� --- USE,_ Cf- Phone Contractor's Na ..�_ - ` ryI� Installation will serve: Residence L��pertment Douse ❑ Commercial ❑ Tral er Court ❑ Motel ❑ Other ❑ IIS; Number of living unit's: dumber of bedrooms�Number-of baths�Lot size ___' ��.. ---------------- Water Supply: Public s ste..' Community system Private Depth to r Table -------- ft. pP Y� Y ❑ Y Y l ❑ p Character of soil to a depthI of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made:': (If yes,date---------------------) No ❑ New Construction: Yes ❑ N FHA/VA: Yes ElNo ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if pu 'r sewer is available within 200 feet.) -Material dfr' 'r'-. Septi *Tank: Distbnce,from nearest well :- __�Distanci from fou dation__ 1I No. of e�om artments__ _- ---- ---------_ ___Size__ __ Q-- -__Liquid depth_, Z_.-_______-_--_-Capacity__®.1-.,0 __ p ,�-- Dispos I Field: Distanc4from nearest well - Distance from foundation__./P__----.Distance to nearest lot • N Len th_of.each line- -ft__-- 1------/�- -.Width of trench-__��__ ---.--------------------- � Numberi�of lines __t-f _-- = - t g q { �� Type of filter material �cG.____ _-._Depth of-filter material-_�- `f_____._.-Total length___-___c am .`____________________ See Pit: Distance'to nearest well -.----____Distance from foundation___________________ Distance to nearest lot line____--_____------ F �„ j Number of pits----------------------Lining material --- -------------- .Size: Diameter-----------------------Depth--------------------------------- I : e t i p a- Depth dation Lining material ass ool: Distance Diameter nearest well__-____-____-___Distance from foun --- ----------------------Liquid Capacity_--________________________gaffs. ' ❑ -___Distance from nearest buildin _--___-_-- Privy: Distance'from nearest well-.-._____._--------------------------------- 9----- - - ----- _______-- ❑ Distance to nearest lot line---------------------- Remodeling and/or repairin�9 (describe): --- ------ --- --------- -------. -- --- ` ---- ------------------- ------------------------ 1M=------------- ----- _- ./�� = -------- III 1 I hereby certify that I lave 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 Heal7histrict. (Signed)- ' / f------ -------------•----------- ----- ontractar �- --- .ff�, --- -- ncn tle]- ��f�� ] - - -� ------ -------------------------------------- - - - -� - - - - - - ---- - --.� ee laced on reverse side.---- - - ._._.....-_ -.-- l,Ft,, �y:.t (Plot plan, showing size of lot, location of system to relation to w buildings, p ] 'IN ;II FOR DEPARTMENT USE ONLY APPLICATION ACCEPTEd"BY - -''I-- - ------------- -----------------+---------------------- DATE----2�=Ael -kb------------------------------ REVIEWEDBY IIS'= -•--- DATE------------------------------------------------------------ BUILDING PERMIT ISSUED--8 ----------------------------- ---------------------------------------------------- DATE------------------------------------ ------------------------ Alterations and/?(—recommend ati n � -------- ----- ------------------------------- ------------ ----------- ------- -------------------------------- --------- ------------- ------- �vf .. ----- - ---------- ---------- ---------------------------- I� -----------------------•----- --------------------------------- ------- --------------- ------ --------- ' 1 INSPECTION " Date------------ ----------- ------ - ------------------------------ FINAL� � f 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.C .