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j } I S: �S -------- JOEo APPLICATION FOR SANITATION PERMIT - - Permit No. ..1.__D._.3 C� --- ------------- ------ --------- ---------- [Complete in Duplicate} This Permit Ex ires 1 Year From Date Issued Application is hereby / Date Issued y made to the San Joaquin Local Health District for a permit to construct and install the work h This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION___" herein described. - Name-_c ---- Owner's ---------- ---•---•---------- ---•------------------------------ ---------•-------------- ------- Address -- - -Address---- � - ---- Phone-•- ` --------------------------••--- Contractor's Name -------- - --------- ----•• _..__""--"_"_""_Y_______________________________________________`---- Installation will serve: p = --- ---------- ---- --- .�-t Residence _ ��-------- Phone_------- C '"A artment ouse ❑ Commercial ............. Number of living units: ___ __ Number of bedrooms __ ❑ Trailer Court _❑ Motel - ❑ Other ❑ Water Supply: y Number of baths _ Lot size "_Publics stem ❑ Community system Y-7? ®------------------------------- h __ Character of soil to a depth of 3 feet: Sand Private � epth fo Water Table d ft. ❑� Gravel ❑ Sandy Loam ❑ Cfa Loam � Previous Application Made: (If yes,date----- "--_ ,...�/ y ❑ Cla Y ❑ Adobe 16—Hardpan ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: 1 No ENew Construction: Yes ❑ No R (No septic tank or.cesspool permitted if public sewer is available within ❑'r FNA/VA: Yes ❑ No r Septic Tank: Dis#ante from nearest well_=�'�"� 700 feet.} -.-"-Distance from foundation__.!A_ r No. of compartments.-__- 5ize___-_ �- ----Mate1ial---�cs�+�C'a(1 _-------------- ------� Disposal Field: y`� 't --------Liquid depth_------- ----__� Distance from REdreSt well_�S? r - _Distance from foundation___ ©"� Capacity___"3,'c: R Number of lines---- a__"--------- __."_.Distance to nearest lot line__+f- Length of each line--^ ' Type of filter materia �__fC Depth of filter material J-----`--- "_".Total . of length french'__� '� Seepage Pit: ,f Distance to nearest well"/Ces_r ---------Distamt f 9 ---------------------------- 04--- Number of pits.-----/----_--- Linin material --f-pC/ i m foundation____ Q" _ ".Distance to nee+est lot j .I~ Lining (-_'Size: Diameter------Distance from nearest well-----""."-- `-3 '� ----Depth--------"_"__ Distance from foundation.---------_ Size: Diameter--------'----------------- ------- .Linin ---- ----Depth................................. _g inateriaL---------------------- ---------- Privy: Distance from nearest well Liquid Capacity-- ------------ ab" --gals. ❑ Distance to nearest lot line__.._ __ D stance from nearest building_ Remodeling and/or repairing (describeJ---------�" "-"-"""_"----"-" g - - ------ ---------------------------------•--------------------------------------------- i------------------------------------------ ------------------------------------------------------------ ------------ ----------------------------------------------------------------------- -- ---------------------------:----------- I hereby certify that I have prepared this application and that the work will be done in accordance with Sa n Joaquin Count ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. y . ------- - - ...x.w,r (Signed)---- _ ----------------- -- - By: (Owner and/or _ �O d/o Contractor) (Plof plan, showing size of lot, iocatio of system in relation to welts, buildings, etc., (Tifie)--------------------- be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY"-- f , REVIEWED BY--- ----------------------------- ------ DATE---- 1 - 1, �_(oS. BUILDING PERMIT ISSUED__. - ---- ----- -- --- ----------------- DATE---.------ -k--" ------- ---------- -------------- Alterations and/or recommendations:.__- l--,_ S'�! -------- -�-S-� 1'1 ""-------- - - --- ----- -- -------- � " . - --- --------------- ------------------•------------------ - W _ �� 1 ::. . — --- ----- _------ ------------- --------------- f — ------ ------------------- INAL INSPECTION BY:..---" : - ------- ------ Dafe-- •--I, . , y ----- ................ 1601 E.Ha:ellon Ave. SAN JOAQUIN LOCAL HEALTH DISTRICT 300 West Oak Street Stockton,California 124 Sycamore Street Lodi,California 205 West 9th Street Manteca,California F.P,ro. `'-Tracy,California