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FOR OFFICE USE: ------------- APPLICATION FOR SANITATIOKI PERMIT Permit No. . .................... (Complete in Duplicate) - -- �5 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. ) G .......----------------------- ----- ------------------•------------- JOB ADDRESS AND LOC ION___3'��-�--i--.'-'�,1 --2---- ------ - -- - - Owner's Name------------*------ - -----} e ------- - ---------- P e Address-----•----------• �r - �` � Phone---------------------------------- Installation Name---- 3----------------:J--l�_14e------------------------ -------- t Installation will serve: Residence .IApartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number' of liv.in$ nits: _ _ ber of bedrooms _- umber of baths __ size _____-/—�_ ----------5 4 Water Supply: Public system ❑ Community system ❑ Private Depth to Wa#er Table ft. Adobe Hardpan Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ / � ❑ Previous Application Made: (If yes,d�--------------------} No ❑ New Construction: Yes ❑ No FHA/VA: Y ❑ I`1 I TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool pe�mitted if pub sewer is available within 200 feet.) �1 Septic Tank: Distance from nearest welC__3r'--- ---Distance fromfoundation a_____._.Materi� No. of compartments________________ .Size__ _ ,' .,1._J(- Liquid depth------ - ------------Capacity----- �i' L ..__._.Distance to nearest lot li ------- Dispo a Field- --------------- from nearest welL `b__.._Distance from foundation___._ Number of hries'____________________2-2—'___Length of each line----------.-" Width of trench....__._,fes--__.__--_--_---- -- G, / t- -----Depth of filter material----- _-a/Total length------/et --- ---------------Type of fi4ter materiaL___.�. - 5eepa ePit: Distance to nearest well. _ U-----Distance from foundation____________________ i)tance # nealot line__._ _ Number of pits._.__./_-_-__._ :__Lining material____ '------Size: Diameter__�_��---Depth------ ---------- i Cesspo l: Distance from nearest well-----------------Distance from foundation_.._._..----------.Lining material-_.__...___-_--___.---------- al-- ( i -----Depth:- ------------------------Liquid Cap9 El .�..a Size: Qiameter___-�-------•-- ---- acity � 11 _ Distance from nearest-b0clin Privy: Distance from nearest�wel............. ----------------------------------- s 9------------------------ ----------- -- Distance to nearest lot,,line...._ --------------------------------------- �,, -..fir ... .. �/ —�_ � (' and/or repairing'(de74b-e�:`_t--- .-Es /6i"-.------ or/ --- R _c ----------------------------------------- Remodeling } 3r / }��_ f J --------------------------------------------------- ------------------------------------------------------------------- -------------------------------•-------------------------------------------------------------------------- ------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County�- ordinances, to laws, and rules and regulations of the San Joaquin Local Health District. (Signed)-_ - ----=--- --------------------------- ---------------- (Owner and/or Contractor) BY� ------- ---------------------------------------------(Title)-------------------------------- ------- -- -------- By. -------------------------- -- i (Plot plan, shZ size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). f EPARTMENT USE ONLY APPLICATION ACCEPTED BY------r------------ - ---- ----- DATE------- _ .__'_� _ - _ - ----------------------- - --------- DATE REVIEWEDBY---- ------------------------ - ---- ----- - --- ------ -------------------------------------------------- BUILDING ---------- - l3UILDING PERMIT ISSUED --------------------- DATE------------------------------------------------------------ --------------------------- Alterations ------------- Alteration sand o„�recgmmendations-------------------------------- I ------------ ------�------ r, p 1 A-------- 4_, l I � ---------61 -�.- �-t-�------------ .✓ -� � '� �k�d -�-e-= ----- ---- f��+��......... sl^4 �1 r D ` ---- I INAL INSPECTI N BY:---- ---- Date --�- ---- - ------------- --�------�-- AN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California j Lodi,California Manteca,California Tracy,California