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OR OFFICE USE: ,� L ----yT 6 5 - l-I ------------- - ------- �� x _f�_ --.-.._"-""___--__-.- APPLICATION FOR SANITATION PERMIT Permit No. .. ._.�--5 --------------------------- -------- ----- (Complete it Duplicate) Date Issued ------------------------"--- ---------------------------- 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. J08 ADDRESS AND LOCATION. .? .- -------------------------IN-------------------------------- Owner's Name-- -------•--•-----------._�c�1 Z-r�`V --------------------- ------ Rhone-= --------------•--•-------- C> �---- Address----------------- r ------=- ----- -----------101/- ' Contractor's Name---- � -° '�---- fe':._ Phone.. ' Installation will serve: Residence i Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ e Number of living units: _I____ Number of bedrooms J---- Number of baths _/__ Lot size __.-7S---X___/ ' -----•- Water Supply: Public system M Community system ❑ Private ❑ (epth to Water Table......... ft. h Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam p Clay Loam I❑ Clay ❑ Adobe a Hardpan ❑ Previous Application Made: (If yes;date---------.----------) No ® New Construction: Yes g No,❑ FHA/VA: Yes ❑ No E' 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__f�-----_Dilstance from foundation__:_��---------Matenai.... No. of compartments ----Size---- -X,S�X---y--------L'i uid deoh t Q p tments- q . „ i? _CapacitY --t Disposal Field: Distance from nearest well-o�......Di}stance from foundation.-_�G__ __.-_-Distance to nearest lot line___''___ f a� Len th-of each"line_ " S--��'`--Width of trench-------- ---r------- J Number of line's`._._____ __ g Type of filter material_ _ _ _________________Depth of filter material_`____r�_`.�_____rTotal length________l.f__ ___ __-__________.- p g I --" f ____.___:.Distance to nearest lot line-------______--_ p ,9 ----.Size: Diameter- = ------ "---Depth---- 'Z s� -------------- See a Seepage Distance to nearest welL___Nr%_________:Distance from f undatian___;_��` Humber of �ts___.__.Z-_____-_-_Linin rriaferEal______ ._-- Cesspool: Distance from nearest well-----------------Distance from foundation-_--------------- .Liping ma#erial______--__.______.____.____________ . Diameter = De Depth❑ Size: ------------ z;------------Liquid Ca actY ' =e' gals. w. - .-._� Privy: Distance from nearest well--------- from nearest buil- ❑ Distance to newest lot line_________________ I Remodeling and/or repairing (describe):__------ _--------------------------------------- I I ----------------------------------------------------------- --------------------------------------------------------------------------------------------------------------------------------- ---------- ----- I hereby certify that I have prepared this application:and that the work will'6e done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. i /[.c'-Q� --- '------------ ---- (Owner Contractor) (5igned)--------/f --------- • -• --------- �-- ---------'--------------- ------------------ --- - - --- ----.-.-O er os Plot Ian. shawin--'size of fo location -- - - -- - - - -- Title .--- ---•---- - - --- -- - --- ------------------------------------------ ( p tion of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPART T USE ONLY APPLICATION ACCEPTED B f - --------- ------ --------- DATE -' - ------�----------- REVIEWED BY-------------------------------- --E ---------------------------------------- DATE---------------------------------- BUILDING PERMIT ISSUED----------- = �I DATE------------------------------------------------------------ Alterations and/or recommendations: ® _,. �_ -�. ---------- --------- ---------------•---------------ro:----- --------------------------------- `= I ----------- ----------------------------------------------------------------------------- --------------------------------- --------------------•---• -- ------------------------------------------------ ------------•--"------"---------•--------• ,I €.! E) FINAL INSPECTION BY: _ I2 �--------- ---- --------- --- Date J / `_ 6 5 `- `SAN JOAQ LOCAL HEALTH:DISTRICT'S '? 1601 E.Haielton Ave. 300 West Oak Street I 124 Sycamore Street 20S West 4th Street Stockton,California Lodi,California Manteca,California Tracy,California i� F.P.0 q. } 1`" t JI