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FOR OFFICE USE: j= �^ --------------------� Q� G ,.---__-_- APPLICATION "FOR SANITATION PERMIT Permit No. - ------------------------------------------------------ (Complete in Mplicafe) s - • . Date Issued -------------------------------------------------_ _ . This Permit Expires 1 Year From Date Issued Application is hereby made To the Sin Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with CSRnty Ordinance No. 549. f JOB ADDRESS AN C TION �l .. . - - .._oL � C -i''I �[ --•--e--------------------- Owner's Name-----------_�CK�6f----------- 1r-S- J_a^ .V)----------------------------------------------- ------- Phone-TV- Address------•---- ...------.Ike---1------C - Lar '---•---------------------------- ----------------------------•-------------------------------------.....-----------------•-•------------ Contractor's Name--------•--------j-u: �-Y7�---------------------------------------------------- :----------.-- Phone----•• ... Installation will serve: Residence Mi. Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __,_--- Number of bedrooms -3.- Number of baths __��- Lot size _____._A, -- -----• Water Supply: Public system D?( Community system [:] Private F-1Depthto Water Table _ --_ ft. Character of soil to a depth of 3 feett Sand El..•Gravel-.❑--Sandy-Loam-❑-.,rClay-L-oam_(Dt.._Cla.y-❑...,..Adobe 0 Hardpan ❑ _,, Previous Application Made: (If yes,dateNo ❑_ Now_:Construction: Yes No ❑ FHA/VA: Yes ❑ No �J_hl/4�-__1 TYPE OF INSTALLATION AND SPECIFICATIONS: , i4 .- + No septic tank or cesspool ermined if ublic sewer is available within 200 feet.) { P P P P�_. _ m - - --v�--�. -r- Septic Tank: Distance from nearest well--N-A-----Distance from foundation----- -------Material_____C 1_______ ______ __.-___._ _ .. (� No. of compartments----------D. --------Size__1xq?CS------------Liquid depth--�:_=4-_ra-----.---- Capacity-----2pa f-� - �=t Disposal Field: Distance from nearest weil__N-)_S'1-----Distance fromfoundation_---k3._____---Distance to nearest lot line___�r"______-____. Number of fines-- 3----------------------------Length of each line--aO 1-'f°�_�`f°�Wid#h of trench------ �-_____-.___.____-_- Total---length-----------1—q------------------- Type of filter material-_�14rC,�...__Depthrof=filter-material--.��.:�_-__:- __ � , Seepage Pit: f Distance to nearest well--------------------_Distance from foundation______.----____-.--.Distance to nearest lot line-_-_--_______---_ J ❑ Number of pits.... `------------------tel-ining-maferial---------- ------------Size: Diameter----------------------Depth-----------------"-------------5 I i Cesspool: Distance from nearest well- ---------------Distance from foundation._,____---_--_---..Lining material------------------------------ ❑ Size: Diameter----t- -------------------------.----Depth----, _ r -------- - ----- ----Liquid Capacity-..-------------------------gals Privy: Distance from nearest well.___________ _____________-.--___-- Distance from nearer, st b iiding----------------------------------------- ❑ Distance to nearest lot line----------------- ----------------------------- --------- -------------------------------------------------------------------------------' Remodeling and/or repairing (describe):-------- ------------------------------------------------------------------------------------I -- -----=�'------------------------ ---------------•---------------------------------------------- -------------------------------------------------------------------------------------------------------- --- = % 3# r. - -------------------------------------------------------- ------------------------------------------------_---------------------------------------------------- 1 hereby certify that I have prepared this application and that the work will-be done in accordance with San Joaquin County d regulations of the San Joaquin Local,Health District. ordinances, State laws, and rules and _ (Signed) - - --------- - -- - -------------------------- --------- ------------------ - (Owner and/or Contractor) BY� 1----------- ------ --------------------------------------------------------- -------(Title)-------------- -------- ----------------.---...---------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). I ( FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------- ------ -------------------- A DATE- -- J ------ -------- REVIEWEDBY------------------------------------- ------------ --------------------------------------------------------- ------ DATE------ ---------------------------------------------------- BUILDINGPERMIT ISSUED-------------- 1--------------- -------------------------------------------------- - ---------------- DATE----------------------------------- -------------------- Alterationsand/or recommendations:--------------------- --------------------------------------------------•--------------------------------------------•-----------•---- --••------------- ,1 _r?----------- - -- )----------- FINAL INSPECTION BY:. --- D t �� SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Harelloo Ave. 300 West Oak Street 124 Sycamore Street 205 West 911h Street Stockton,California Lodi,California Manteca,California Tracy,California