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FOR OFFICE USE:" ------------- ------- --------- --------------------- l ------------------------------------------_---.--_-.-- APPLICATION FOR SANITATION PERMIT Permit No. _ 1P. - ----- -----� -.---- --rr tr l (Complete in Duplicate) '0-- � - - This Permit Expires 1 Year From Date Issued Date Issued / g0 - 3(-o o 2.. Application is hereby made to the San Joaquin Local Health District for a permit to consif uct and in all thew rk hcin This application is made in compli;ince with County Ordinance No. 549 e JOB ADDRESS TION--- ---------- - Owner'sNa --•- ---- ------ Q ---------------------------------- ----- Phone--4I2-q_--(o Q - --- - - Address------p __- -� _ -------------------•------------------••------ ---- Contractor's Name ..... • 4:- Q114,--.t---t V ------------------ Phone- f?..'. f V Installation will serve: Residence artment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _1--__ Number of bedrooms - mber of baths -_ -___ Lot size ---- _7o-10-to7-c _ b------ Water Supply: Public system E] Community system 1-Private ❑ Depth to W r Table - .- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Clay Loam ❑ y ❑ Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date------------------- No Z""New Construction: Yes No ❑ FHA/VA: Yes ❑ No R�-- TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if epubli sewer is available within 200 feet.) Septic Tank: Distance from nearest w IL4�a!__--Distanc fro found tion..- _©_� Mate iaf ' No. of compartments___- ----Size-,3 �_-Y-'�6)Ldl'quid depth-.__.--- _t_Capacity----- Disposal Field: Distance from nea est well-----------------Distance from foundation-- `___Distance to nearest to �r5e r Number of lines-_ _----. __- Length of each line---� -----."Width of trenc ----_- ' - -- _ Type of filter mater -- - _ . - -_Depfih of filter material---_.___-_�_�___Total length------------------------------ _ � m Seepage Pit: Distance to nearest well----------- -_Distance from foundation--------------------Distance to nearest lot line__--.----.---_-- ❑ Number of pits----------------------Lini material----------------------.Size: Diameter-----------------------Depfh--------------------------------- Cesspool-, Distance from nearest well-----------------Distance from foundation._____--------------Lining material--.-..__----------__.__-----_ ___ Z ❑ Size: Diameter------------- ------------------------Depth----------------------------------------------------Liquid Capacity--------------------------gals. a Privy: Distance from nearest well-------------------------------------------------Distance from nearest building---.-.-.-____---.----_ ❑ Distance to nearest lot line---------------- ----------------------------- Remodeling and/or repairing (describe):---------------------------_----.- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ I hereby rtify at I have preparVfhisaVppI1'cafionthat the work will be done in accordance with San Joaquin County ordinances a ws, , r4 es d roaquin Local Health District. (Sig ° -------------------- Contractor) By:--------------------------------------- • ----- ----------------------------------- --- ---- ;-------(Title)-- - -'� (Plot plan, showing size of lot, location of system in relation to IIs, buildings, , can be placed an reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY- - _7__j_-R-, ------------------------------------------------I------------------- DATE-- REVIEWEDBY----------------------------------------- ------------------------------------------------------------------------------ •--- DATE-------------- --------------------------------------------- BUILDINGPERMIT ISSUED---------------------------------------------------------------------------------------------------. DATE------------- ------------- - - ------------------------------ Alterations and/or recommendations:----------------------------- ------------ - ---------------------- ----------------------------------------------------------------------------------------------------------------------------------------------- FINAL INSPEG Date-. - - --- J - SAN JOAQUIN LOCAL HEALTH DISTRICT 7601 E.lfazellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.ro.