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FOR FFICE USE: Sr �f------------ a: APPLICATION FOR SANITATION PERMIT Permit No. �` (Complete in Duplicate} ' ------------------------------------ ..-. --- This Permit Expires i Year From Date Issued Date Issued _C �SrC 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 compliance with County Ordinance �No. 549. JOB ADDRESS AND L CATI N•.•._�- - (�✓Q� -------------------------------------------------------------------------• -------;-------------- Owner's Name----------- A--- ,= � ------------------------------------------------------------------------ ------------------------- Phone-----•---------•-------------------- Address------------- `J ` j �Ct c'� 'i.� ---------•-•----- Contractor's Name------- ,_: a �` ` �r�-«.� , �114�Y Phone_L 3`l - `f/ Y'` Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: Number of bedrooms_J... Number of baths ..1-.._ Lot size ------- .X./_�- -------------- Water Supply: Public system Q Community system ❑ ' Private M'."'Depth to Water Table -:70- ft. t 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 V?"No ❑ FHA/VA: Yes ❑ No 0_ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if pub lic sewer is available within 200 feet.) Septic Tank: Distance from nearest well___0------- Distance from foun dation----ho--------- Materiae.--- 1K No. of compartments...-. --....-- "-- Size fW-b___X_f----------Liquid dr. th.__..__ -------------Capacity--A Disposal Field: Distance from nearest wgll._. _'7F_Distance from foundation..._fe._1`'_..Distance,to nearest lot line... `. �- _--. .Length of each line__ _ Number of lines----------------- ------ �"��_ Widt�i of trench.-------.w'-�.-.---- - ------- Type of filter matenai Depth of filter material___..( .-.-------Total length-----------I1�-..-.___--__ Seepag i1P`!nt Distance to nearest welle/ ..' ----Distance ff�om f undation..._�¢. ___.D'stance to nearest lot line_.. 7 � Number of pits-----------�- _ _Lining material----/�ti�.--.Size: Diameter-Y�XIa C.----.Depth.-..-./X:----------------- Cesspool: Distance from nearest well-----------------Distance from foundation..... ..........._Lining material--------------------------- � ❑ Size: Diameter- -- ------ - ------ ---------- -----Depth---------------- ----------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well---------------------------------- ----------- --Distance from nearest building------------------------------------------ F1Distance to nearest lot line-- --- ------------------------ -- --------- -------------------------------------------------------------------------------------------- - Remo eiing and/ori rVairing (d scribe)A&./V44r±a[Gr_-- v+�' +�^-_Lrr��,Gf.� •e!K•�- or -- L p Pkv --------�0 -- ro -- -- �� I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Stale laws, and rules and re tions of the San Joaquin Local Health District. (Signe6d) , g ) � `"'-_ _t .,.. ✓- ----------------------- (Own and/or Contractor) By:---------------------------- ---------------- ------------- -----(rifle)--------------------------- - - ---- - ------ (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------- - n.1 -�------------------------ ----------------------------- �Z �G------------------- DATE.--- ----- ------ ---------------- REVIEWEDBY---------------------------------------------------------------------------- --------- -------- ----------------------------- DATE----------------------- BUILDINGPERMIT ISSUED----------------------------------------------------------------- ----------------------------------- DATE--------------------------- Alterati ns apd/or rec m end tions:- -- --------------------------------------•----------------------------------'-------------- -- ---r-`-'2-- -�J.Ir�----��- -------- '° -\f'r' n - A .y ------ -------------- ------------------------------- ----------------------------------- - ------ ----------- ------ ---- ------ ---- --- ------ ./QZ_ / -� ; � / ------- _ FINAL INSPE_ - --------- -- --- ------------- e. Cd SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.r o,