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FOR OFFICE USE: ------------------------- �2 --------------------------------------------- ------------ APPLICATION FOR SANITATION PERMIT Permit No. --------------- ---------------------------------------- (Complete in 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. JOB ADDRESS AND LOCATION---- -C1 �-- --- -�- ------ II—Z" -- Phone--------- -------------•--------- Owners Name----j/__ �- -------------- --�R-�.......VL----•-5' Address---------- ---------- 4------/1 .------- --- -- 3 ` ------••-------_ ----------------------------------------I----------------.... Contractor's Name------------411PT-�r4• ---- - - "= st 'Gr/� SF' �//t C �!Ia' -------------- Phone_ .?' • --•-- Q - ---- ------ Installation will serve: Residencej[j/Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -/- Number of bedrooms __, _ Number of baths __/_. Lot size ---l_"505 -------------------------- Water Supply: Public system ❑ Community system ❑ Private < Depth to Water Table S0 ft. } Character of soil to a depth of 3 feet: Sand ❑ Gravel [] Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe®" Hardpan Previous Application Made: (lf yes,date---------.----------) No ❑ New Construction: Yes ❑ No N' FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: Q (No septic tank or cesspool permitted if public sewer is available within 200 feet.) I eptic Tank: Distance from nearest wet-----------------Distance from foundation--------------------Material------ --------------------_______-----...______. No. of compartments--- - -------Size--------------------------------Liquid depth---------- -- - ---------Capacity------- Disposal Fuld: Distance from nearest well-5- '--..-.Distance from found ation...34--------Distance to nearest lot line--------rd"' Number of lines-------Z-------------- ---------Length of each line-Z,00---------------- _. _. --- _.__.W;dth of trench __-I----------------- Type of filter material_ ��_ Q� Depth of filter material-__IX-'-f length-________------�.Qd_----------- s ' Seepage Pit: Distance to nearest //welf_�rS4-457foundation____ U___ Distance to nearest lot lin� ___________ T Number of pits------t_______ Lining material---lr0- -------Size: Diameter._ __.----.-----Depth-.---- ------------------- Cesspool: Distance from nearest well-----------------Distance from foundat'on--------------------Lining material----._._---._..---_____----_______-. ❑ Size: Diameter'---- 1---------------------------- Depth----------------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well-_.._____.-_...i---____---._-------------------Distance from nearest building----------------------------__-_.._---__. ❑ Distance to nearest lot line------ ---------- ------------------ --------------------------------------------- Remodeling and/or repairing (describe):-_---._------------------------ -------------------------------------------------------------- -------------------------------------------------- -------------------------------------------------------------------------------------------------------------------------- ---------------------------------- --------- ------------------- ---- ------ -------------------------•--------------------------------•------------------------------------------------------- - --- 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 regui tions of the San Joaquin Local 1.Health District. (Signed _ _ -- ------------- - ----y - an r Contract �-.{ caner d/o or Y '---------------------------{Title)- IB ' ------------------------ -----•---- - ---- (Plot plan, showing size of lot, location of system in relay to wells, Buildings, etc., can be placed on reverse sidel. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----------- r--- t *a '`` ------------------- ------------------- DATE-------�- ,_2 -:6��.--------------------- REVIEWED BY----------------------------------- --------- --- --------------------------------------------------- ------------------------ DATE-------- ------------------------------------------------- - - BUILDING PERMIT ISSUED----------------------------- ------ ------ ATE---------------------- - c i.J 2 �r[�xrs�,�7`4rJ L�dam -' -_.0-r_'P-�•"----�' 11�r- ` Altera+ions and/or recommendations:____._..__ , ...� -------------------------------------- ----- --------=--------- -------- _ ----------------------------------------------------- r x s ---------------------------------------- --------------------------------- ----------------- -------------------- ------------------ d-G�� FINAL INSPECTION BY:.... C- --- ------------- ----- Date �� SAN JOAQUIN LOCAL HEALTH DISTRICT 1401 E.Hazellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California F-F-r-E.