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FOR OFFICE USE; 30 _ { � � -- ---------------- ---U-.- APPLICATION FOR SANITATION---------- --___/_ � S � PERMIT Permit No. ------------------------------------------ (Complete in Duplicate) 7� Date Issued .._. --------------------------------------------------------- This Permit Ex fires rt Year From pate 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 /(_ Owner's Name----------- b -------- /�; ;--- ,� Phone--------------�- Address----------------------- t = -C� ct - { M Contractor's Name '� ---------------------------- --k------ -------------.-------•------------------------ Phone----_-----•-----................. � Installation will serve: Residence rtment He sue E] Commerc ial [❑ Trailer Court ❑ Motel [❑ Other [I Number of living units. /..... ber of bedrooms _- Numbe� of baths __/_ Lot size ------ .__ r„ .__ _ _____________ ____ b Water Supply: Public system Community system ❑ Private E]l Depth to Water Table T ft. r Character of soil to a depth of 3 feet: Sand E] Gravel E] Sandy L. am ❑ Clay Loam,❑ Olay,❑ Adobe ardpan ❑ € l—< ❑ / ❑ Previous Application Made: (if yes date....................) No,�w•Cbnstruction: Yes o FHA VA: Yes No TYPE OF INSTALLATION AND SPECIFICATIONS: t (No septic tank or cesspool permitted if public'sewer is available within 200 feet.) Septic T Distance from nearest well----- from / �y P � � � �-y �foundation�Q______.____Mate�aL_.-- No. of compartments---- `Size_ __+�_ _ a.__:_.Liquid depth_-----5�/� ___-._Capacity.-&= --_..__- Disposal F• Id: Distance from nearest well- _---Distance from foundation---- -Z--- ---_.Distance to nearest lot line__ �- L'en' th-of-each line_. i Width of trench---- _ _- --- f, Number of lines------- Type of filter material-._1-71� Depth of filter material----�Ij_.-_.-Total length_. ---------------___________ Seepage t' Distance to nearest well--- --_-_-.---_Distance- m-found-ation-__-��_._--.Dista-ce�o nearest lot iine_S.,� Number of pits---- _..------Lining ma Size: Diameter. J?__-.-___De th,_ P Cesspool: Distance from nearest well---------------_-Distance from foundation.------------------ Lining material_-----._--__----_------.__.----------- - ❑ Size: Diameter-----I-------A---------- - -----------Depth------------------ -------------------------------Liquid Capacity-.--------------------------gals. Privy: Distance from nesrest'well---------------------------------------------------Distance from nearest building ' ❑ Distance to nearest lot line --------------------------------------------------------------------- --------------- Remodelingand or { airin d scribe :_.a- / P g -�r�` -. ef�� - -- ,- ----------------------------------- -------------- ---•--------- --- -------------------------------------------------------- --------------------------- -----------•-------- -------------------------- z- ------------- --------------- -----• -•r - O -------"-----------------•--i----------------------------------------- ----------------------------------------- - ------------------- s�. I hereby certify that I have prepared this application and that-+he work will be done in accordance with San Joaquin County ordinances, Stat sVdar, ngulations of the San Joaquin Local Health District.(Signed) - J •� -�� r-------------- (Owner an r Contr-- `'- gr - --------------------------------------------(Title)-- > Q - o actor) (Plot plan, showing size of lot—, 1`ocation of system in relation +o wells, buildings, etc., can be placed on reverse side). ` FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-- --- --` ' = - !- DATE ` :774�' ---------- REVIEWEDBY-----------------------• -------------------------------------------------------------------------- ---------- ------ DATE------------- , BUILDING PERMIT ISSUED-------------- -------------- D ---------- �- Alterations and/or recommendations--- -- --------- ff ------- ------ ------------- ----------------------- '------------------------ ------------------------------- --- -------------- ----------------- ..---rI--------------------- ----- -------- . -------------------- �r�- FINAL INSPECTION BY: �-�-�--�- � -- - ----------- ---`---- - ----- -- ----- Date..........--- -- - �-�!-- -- -----�-�--- - --------------------=-----� -r s SAN JOAQ LOCAL HEALTH DISTRICT ; 1601 E.Hazelton Ave. 'A 300 West Oak Street a 124 Sycamare Street 205 West 9th Street Stockton,California t Lodi;Coliforriia r,Manieca,California t, , Tracy,California F.RCU.