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FOR OFFICE USE: -------•------------------- APPLICATION P9R SANITATION PERMIT Permit No. ::_.�..1� _� t - -------------•---------------- ---- -- ------------- (Complete in Duplicate) //O ------'�'f-I�rf.-4:4 .-_'_•rc'_ �---------�_ This Permit Expires 1 Year From Date Issued Date Issued __� /6__V 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 Com iance with County Ordinance No. 549. MTC. 571 �� JOB ADDRES AND LOCAT!ON -----=-----_��._ - �Rf?N: "�c�� ----- ----!�f__.--PF-----.(--lJ-(`�I�T.H_-----��E-E-----= Owner's Name-------•------ (5 -----------'--`_N__ - '� - - - Phone -.:..per} :_` ---------- Address-----•------•--- " --------- :P..X f�2---•----- M-r' '---------------------•-•------------------------------------------- -` ------------ Contractor's Name.--------C-Wb4-F—_F��------------------------------------------------ -------------------------------------------------- --•--- Phone------------------------------------ Installation will serve: Residence Ej' Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ F;- Number of living units:':_ __ Number�f.bedroroms - ate ber"of baths ___�.__ Lot size ___J 4__ _- -o-p'---------------------- Water Supply: Publics stem Commun' s s eyn ❑ �De pth to Water Table - ft. pp Y� Y ❑ Y�� Y . ' Character of soil to a depth of 3 feet: Sand Gravel ❑ Sandy loam ❑ Clay Loam [],,,Clay ❑ Adobe ❑ Hardpan ❑. Previous Application Made: (If yes,date..------------------) No New Consfructicn: Yes �No ❑ FHA/VA: Yes ❑ No — TYPE,OFA-INSTALLATIONYAND=-SPEGIFICATIONS: -- (No septic tank or cesspools permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well___,�...`_Dis}ance fro foundation-_ I�_�__-_Maatgriaf___C No, of compartments..-_-_ - ----. _ Size._J�_ x---------X-�--_Liquid depth_ ______Capacity._�Z�v-p____ ,✓ Disposal Field: Distance from nearest well.-.IS7Q---._Distance-from foundation____®'____-.Distance to nearest lot line_____--_ Number of lines-------- -- Lngth of line----- of`trench--------2__.1A______________ Type of filter material-_- �3- D"epth off"filter material_______ __ Total length____�__p_ ="" See page Pit: . , Distance to nearest well_____________________Distance from foundation-------------------_Distance to nearest lot line----------------- ❑ Number of pits----------------------Lining hmate�ial-- Size: Diameter - Depth i cesspool. £= Distance from nearest well___._____�._._Distance from foundation____----------_------Lining material_--------------._._______._______ Size: Diameter--------_-=.----------------- - -----De th - = Liquid Capacity------ -galls ❑ f * p i g , , i . � --- I l// Privy: --Distance from nearest well__________ ---_----------- _$, _t-. - --D.stance from nearest building_____..._______.____________..___.----- E ElDistance to nearest lot line----------------------------------------------------------------------- f----------------- ------------------------------------------------- 1 Remodeling and/or repairing (describe):--- -------------------------------------------- -------- ----------------•--•------------------------------------ S t --------------- ----------------------A-)--------------.-:----•--------------------------- --------"--------------------------------------- ------------ ------------------------------------------------------------------- 1 =--------------------------------------------------------------------------------- -------------------------------------- -----------------------•-----------------------••---------------------------------------------------------------------------------------------- ------------------------- I ' I hereby certify that I have prepared this application and that the 7work—will-6—edo'ne in accordance with San .Joaquin County ordinances, State.I; s nd rules and re do of the a oaquin Local Health District. �J C/ (Signed), �7 - ------- -- ----- .(Owner and/or Contractor) _._ __ _ - Title Y - ------------------------------ --------- ---- ------------------------------------------------------( )--- -------- ------------ ------ (Plot plan, showing size of lot, location of system in relation,fo wells, buildings, etc., can be placed on reverse side). ( FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED SY----�r Ko------- ----- ---------------- - ----------------------- DATE-----Z - --� ----------------------- - REVIEWEDBY-------------------------------------------------- -------------- -- DATE----------------------------- ------------------------_--- BUILDINGPERMIT ISSUED ' - =_: =•------------== DATE----------------------------- ------------------------------ + yry t 3 Alterations and/or recommen datio-•-------------ns: '"-- "___ ; s ------ ; a ----------------------------------- - - - ------- --- ------- -- -- ----• - -- ---- ,I --- ----------------•--------------•-------------- --------...--- ------- --------- r E ! .• ________________________________________ _ ___ .._. _ _ ____.___._____.--------------------------------- ._____.._______._..________.._._a u_ ---- Date-- :a FINAL INSPECT B - ---- t��- -- -- `------- {-�=---------� � �-----^---------- ---- ----------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Ha:ellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California 2NIanteco,California Tracy,California =..' F.P.0 O.