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FOR OFFICE USE: f/ 3() ;2�---------- ---- ----- ------------ --- ---/``_` APPLICr;TION FOR SANITATION PERMIT Permit No. ...�Q_.3�S 4 —,. [Complete in Duplicate} �3Z3_-Srru -+.£moo �p- _, This Permit Expires 1 Year From Date Issued bate Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. �JOBThis application is m de in compliant with Cou ty Ordinance No. 549. -rs-_ �Op7 7 /•�`� � 7-cell" ADDRESS AND LOCATI N----- -- ''-�--------�-------�.Owner's Name------ ... ^� -y �1 ' �`'^--- 7z. -------------- ------ Phone-_.--•-----------------........... Address__ Contractor's Name �� = 1- :---------------------- - -.-. Phone----------------------------------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ___.- Number of bedrooms ___1 Number of baths/____ Lot size ......t4- _e'___ E' l______________________ Water Supply: Public system D111—community system ❑ Private ❑ Depth to Water Table r ft. - Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay [] Adobe [Z-'Hardpan F]. I Previous Application Made: (If yes,date--------------------J rNo ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Trak: Distance from nearest well__- ~___-___Distance from foundatio Material---x-_GC_G4 `LF'___ ®� No of 'compartments-------- --------------=Size" - --4r_?�- 7-----.Liquid depth------ - ------------Capacity..... -t -_---- to Disposal field: Disfance from nearest well.. `°"___ Distance from foundation/_G'__f-___--_--Distance to nearest lot line___,____.-____ ©O dumber of lines--------_a,__I__-._--_.______Length of each line---- C _-_tq-------Width of trench_ _� - �r W Type of filter material----,�/--,_-12e:# Depth of filter material____ ,'_ --------Total length___� _______________________ .n Seepage Pit: Distance to nearest-well----------------------Distance from foundation--------------------Distance to nearest lot line---_--____-_____ , ❑ Number of pits----------------------Lining material------------------------Size: Diameter---------------..-___,.Depth--------------------------- Cesspool: Distance from nearest well-----------------Distance from foundation.-------------------Lining material-----------.---------------_---___.-_. ❑ 'SYe: Diameter---------�------------------------- Depth.---- �---------------------- --------------------Liquid Capacity----------------------------gals. 0 Privy: Distance from'nearest well_____________________________________ __ -..__Distance from nearest building___________________________.-__-.-___ ❑ Distance to nearest lot line--- --- --------------------------------------------------------•------------------ ------------- } Remodeling and/or repairing (describe): - �{r� ----------------------------------------------- j------------------------------------------------------ ___________________________________________________________________________________________________________________________________________________________________________________________-.-.-_-..-._____-____-____-.__._._ �! I hereby certify that'I liave prepared this application and that the work will be done in accordance with San Joaquin County ordinance$, State law , and rules ap. egulations of the San Joaquin Local Health District, . Signed <_ ` lt ---- ----------------------------------------------- ------------------------------------------------ Owner n } ( and/or Contractor) nn BY:------------------------- 4= SIJ . � ------------------------------------------Title � __ ------ ------------ �I (Plot plan, showing size -int, location of system in relation to wells, buildings, etc., can be placed on reverse side]. 4 ' FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_. .- - pATE__�_2-- '_/�� ----------------------------------------------------- - ------------- ----- --------- ----------------- REVIEWED BY '------------------------------------- DATE BUILDINGPERMIT ISSUED------------------------m------------------------------------------=--------------- ---------------- DATE------------------------------ --------- -------------------- Alterations and/or recommendations:---------------------- r -------------------------------------------------------•---------------------------------------------------------- 1 ------------------------------------------------------------------------- ----------- ----------------:-------------------------------------------------------•---•---------------------------------------------------------- ----------------- --- ------ ------------------------------------ - --- ----------------------------------- ----------------------------•------------------ -- -------- ------------------------------------------- FINAL INSPECTION BY:.------- ------------ - ----------- Date---- ....... - -- ---------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1801 E.Hazelton Av*. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California f.P.co. i