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FOP,OFFICE USE: ------------------------------------------------ -------- APPLICATION FOR'SANITATION PERMIT Permit No. ..4��i.a... --------------------- ---------------------------- - (Complete in Duplicate) - This Permit Expires t Year From-Date'Issued 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 incompliance with County Ordinance No. 549. r JOB ADDRESS AND LOCATION � - --------� '�� Owner's Name--- Phone-,S_73. S1�C/C-± ----- - - ,S -4'-'/ _3 3.GI� �----------'------ -- -------- Phone- ---93. Address- -----`-- U '` ` ---� ---- ----- ------- ------------------------------------•------------•------------------------..-------------------------- Contractor's Name ------------ 1 ------ ---- Phone--4�s/r -3 Installation will serve: Residence E] Apartment House E] Commercial Trailer Court ❑ Motel ❑ Other 'Number of living units: -------- Number of bedrooms -------- Number of baths _ Lot size ___ _ ______________________________ Water Supply: Public system ❑ Community system ❑ Private [Depth to Water Table ft. Character of soil to a depth of 3 feet: Sand KrGravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date---------_----------) No [[fa`�_New Construction: 'Yes (�No ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank ors.esspool'permitted if public sewer is available within 200 feet.) Material_ __ Septic Tank: Distance from riearest well :��-_� Distance from foundation__lQ_____.__ _. . J No, of compartments----,17_ 1 G ize._s� �_X _ Liquid de th_____�-�s:...____---_Ca ac�� --- ---- Disposal Field: Dis+ante from nearest well_- tstance from foundation__.lu.___p....-.Dista to nearest �t line/_0_.__ N� I T e of filter.materia _ ____ ; . - _Depth filter h material � ��s�i•+�th of trench- 9 ,e '��?`�:4 P---.--•------------------ - Number of lines'` _ k Yp P •' D } --._Total length /0 --------------------------- � Seepage Pit: D;sfance_fo?nearesf well_____ __________'_Distance.from foundation----.-------------- Distance to nearest lot line----------------- ❑ Number ofP. s._ -X --------Lining material-----------------------Size: Diameter_- -------------------Depth--'--'... ----------------------- �it _` { . t---------------- .- Cesspool: Distance from_nearest well-----------------Distance from foundation--------------- __. _. - ----------'--. material--------------- .__----------- -0 ❑ Size: � p ------- -----R-;-'---------- ------ ----•--- -- ---Li uid Ca acitY-'---------=---'------------gals. —0 Privy: Dis+ante from neo est well _ _ - ------------------ ...._Distance from nearest building------------------------------ -. ❑ Distance to nearesf lot linep _- __------ ......................... _ Remodeling and/or repairing (describe) _-,YZLAA,.'_1e1 ---------`----------------------------------- -------------------------------------------------------- r ------------•--••--------------------------------------------------------------------------------------------------------------------------------------------- --------- ------------------------------------ -------------- - y ----------------------------------------------------------------------------------------------------------•---------------------------------------------------------------------------------•------ ------------------------- ---------------------------------------- ---------------------------------------------------------------------------------------------•------------------------------------------------------------------------ '------- ----- 1 hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Sj!a!?'jaws, an rules an egulations of the San Joaquin Local Health District. fP - � x ,p {Signed)_A- - --------------- �l � _ _p__f!---lr-- ------ -J- -(OWMT dmf/�or-.Contras+or) BY=----=' = ---•-------- (Title) - ' =_ --- ------- ---.. .. (Piot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). > X FOR DEPARTMENT USE ONLY t L i APPLICATION ACC PTED�� ' L� '-- ��`=. ........ --------------------- ----------- DATE---�-_�� _ ~` j REVIEWED BY t - ------------------------- - DATE- BUILDING - - ------------------ DATE--- __ -------- - t7 _ ; �' ' � �s Alfiet;�ions a /or atom ��d ion :.. f'� - r L&Aao - w r R 7l PK ..... ......... ..... 6 FINAL.INSPECTION BY:.... '--�----- ----- ; Date------- :R ' ' f SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 1124 Sycamore Street 205 West 91h Street Stockton,California Lodi, California .Manteca,California Tracy,California