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.li •ai "�L/`-' S1 9 b�fi 3~,G6 y�l 7 FOR OFFICE USE: Lf i 7 1 O —O EO ------------------- Permit No. �Dz, -- ------ ----- APPLICATION FOR SANITATION PERMIT ----------------------------------- (Complete in Duplicate) — J _ ----- --- 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 a I' n i e in corep nce with County Ordinance No. 549. JOB ADDRESS AND OC TION_dl►_P bra � -- -- ---------I--------- Owner's Name ----•--------- - -------------------------------------------i -------- Phone--------------------- ------------- Address..._�, r •� �-�-� - � -�� - -----------•--------•---- Contractor's Name_(/v-1,� -----------------3-' `� ---��----------------- Phone...-..-.... }i} Installation will serve: Residence ❑ Apartment House✓] Commercial ❑ Trailer Court ❑ Motel ❑ Other [J J Number of living units: ?---- Number of bedrooms/4-- Number of baths 161-_ Lot size --!- Water ! Supply: Public system ❑ Community system ❑ Private,[ Depth to Water Table 70_ ft. 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 Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION.AND+SPECIFICATIONS: G; (No septic tank or cesspool permitted if public sewer is available within 200 feet.)- D, Septic Tank: a from nearest we 1 4Qr-------Distance from foundattiio�n__ C7' s' Material �I'm • No compartments-- ----------------Siz 'i'� �2_� --_ 11_W,�,id depth.-._- - Capacity-344 --------• �. ... h Disposal Field: Distance from nears ell..l�-----_---Distance from fo ndation_±?�-------------Distance to nearest lot line..C,--_----- i•' j Number of lines---� ---`I_---------------Length of each('Zn,,-; of tram ---- - ----------------------•-- 0 Type of filter material•a/f---------------Depth of filter material.-_1_E -------------Total lengfh _-QV=-----___--------.-__-_-_---- Seepage Pit: Distance to nearest well--lam-----------Distance om foundation_j.C1�_.____.-_.Distance to nearest lot line'_ ---------- 0 f3� Number of pits_.!__.-_--_.----Lining material-_/__-___--Size: Diameter.__36`'---------.Depth-. ------" ----------------- Cesspool: Distance from nearest well-------------- from foundation--------------------Lining material-------------------------------------. 7. ElSize: Diameter--- ------------------------- Depth- --------------------------------- ----------------Liquid Capacity----------------------------gals. • Privy: Distance from nearest well-------------- ----------------------------------Distance from nearest building--------------------------------..--.---- ❑ Distance to nearest lot line- - ------------------------------------------------------------- ------ ---------- --------------------------------------------------------- Remodeling and/or repairing (describe)------------------------------------------ ------------------ ---------------------------- ---------------- ------------------------------------------ ----------------------------------------------------------------- ------------------------------------------------------------------------------------ --- . - I ------------- - ------- ----- ---- ------ ---------------- -- -- ------------••--------- -------------------- ------- ----------------- --------------------- ----------------.---- ----------------- ---- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County .00 ordinances. State laws, and rules and regulations of the San Joaquin Local Health District. (Signed).__.____. . her and/or Contractor) B . e} (Plot plan, owing size of lot, location of system in relaflon to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_ ----- -------------------------------------------------- DATI _- REVIEWEDBY--------------------------------------- DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED------------- -----------------------------------------------—---------------------------- ------ DATE------------------------------ ----------------------------- Alterations and/or recommendations:-----------------. -------------------------•-------------------•- -----• ------------------------------ s FINAL INSPECTION BY:_ -------------- Date-_ , - .:. ---------------------------- -------- ---- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haxellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.C C.