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FOR OFFICE USE: ------_----------.------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. .!?� �dr. . ---------- ---------------------------------- --- -- (Complete in Duplicate) O -- -. This Permit Expires 1 Year From Date Issued Date Issued 1..'�/" f�7 - (Co CSO Application is hereby made to the San Joaquin Local Healfh District for a permit to co struct nd i th work herein,de cribed. This a plication is made in compliance with County Ordinance No. 549. �'' S j, �. f-f l 644"h4 F � ; }� �f r JOB DDRESS AND LOC�,TION--Ii'--' -- Ot'----Q/ -- P Owner's Name- 1 `�l �1/��------- P,-/ YW---� Phone------------------------------------ Address __- _�..-,/•Q� ------- ---------------•-----------•-•---------•-------- -------•- Contractor's Name------- -��--=.. ,epa"------------------------- ---- ----- -- -------------------------------------...... Phone---------...................------• Installation will serve: Residence ❑ Apartment House ❑ Commercial PR`frailer Court ❑ Motel ❑ Other ❑ Number of living units: Number of bedrooms Number of baths - ._ Lot size --/�,� ---- --------------------- Water Supply: Public system E] Community system El Private �epth to Water Table 4 ft. aD Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam [] Clay Loam ❑ Clay ❑ Adobe �ardpan ❑ Previous Application Made: (If yes,date---------------_---) No Z�"`New Construction: Yes Pa'�`No ❑ FHA/VA: Yes ❑ No [— TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) `� Septic Tank: Distance from nearest w I__ Q_ Dis#ante from found atipn-_,� /--_- Material--/ fG� - (]�°� No. of compartments---A_-__ ------___SizerO.�1 4':- 43�k-7Liquid depth.-.-�--.__.______Capacityfs`�-_a�-___. p ' � -- Disposal Field: Distance from neares well_ 0_ _,�__ Distance from foundation__/ ___r_ Distance to nearest lot line- _-----.----- Number of lines-.-.- -- -_- _ -Length of each line--_,�--� -Width of trench..--- - �--- --------------- ----------�----�--------- Type of filter material/• Depth of filter material--- length-. p _ ------_-_---------. Seepage Pit: Distance to nearestqell---/A41 --Distance f m fo dation--Z�------Distant to nearest lot iine-4-�__!', ®� Number of pits-___¢-------------Lining material .Size: Diamete r_-, - -.--..-._-Depth Cesspool; Distance from nearest well-----_----_----Distance from foundation--------------------Lining material----- -------------------- F-1 Size: Diameter------ ------ -------- ---------- ---Depth-- -------------------------- ------_---------------Liquid Capacity----------------------------gals. `Vl Privy: Distance from nearest well------------------ ----------------- ---___------Distance from nearest building-------------------------------.----.----. ❑ Distance to nearest lot lire-------------------------------------------------------------------------------------------- ------------------------------------------------ 'f- • Remodeling and/or repairing describe):---- -- ---------- __--� -- - - - - --------• ---_----- ------------------ -- ---- - --------------- - -e_:------------------- - ------------------------------------------------------------------------------------•--------------------------- - ---------- ----- -------- ------- -------------------------------------- ------------------------ ------------------------- ------------------------------------------------------------- - I hereby certify that.,I.have prepared this application and that the work will be done in accordance with San Joaquin County \ ordinances, State laws, and rules regulatio of.the San Joaquin Local Health District. - s a r° (Signed) s C/ •--"'=-------------- = +teffer'Contrac+orj BY -••----------------- `-----------_ ~--------(Title)-- 2Xi/ a (Plot plan, showing size of lot, location of system in relat' o wells, buildings, etc., can be placed an reverse side}. R EPARTMENT USE ONLY APPLICATION ACCEPTED BY-- -----= ---------------------------------------------------------------- DATE------ J7/ REVIEWEDBY------------------------- ------ --- - --- - ------ -------- - ----------- - ------------------------------- ----- DATE----------------------------------------------------------- ` BUILDING PERMIT ISSUED ------- -------------------------- -----------------------------.------------. DATE------------------------------------------------------------- Alterations and/or recommendations:.- V-.,,- -._._ ofr r Q � .' --- Y--�---�p-- --- •-� ----�----- ------------- - --- -- ---- �(f --- '�-- - Or'. e----- -- --- --------- Y °� ��f�r*¢ °;�J !"�' � -W.ur.=h--- f�'� - R - Es--------- s Al) FINAL INSPECTION BY:..---PfS ---------------------- Date.... 0-- " / � ------------------------ -----------------•---- r�JOQUIN LOCAL HEALTH,DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street _-,;Stockton,California Lodi,California ; Manteca,California Tracy, California F.P.r_W. F