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q --FOR OFFICE USE- ------------------ SE: ------------- ----*4}:---------- __ 1 APPLICATION FQR :SANITATION PERMIT Permit No. ----------------------------------------- 1 (Complete in Duplicate) ...... ._ This.Permit Expires 1 Year From Date Issued Date Issued Application is hereby made to the San Joaquin Local Healfh 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 LOCATI N..��--- F--�'t' - - Owners Name---- ' Phone- ---------- - ------ Address------------ ---- Address------------ � _ M 1 -------•----------- ----------------------------------------- -----•-- ----------------•------...---•. .. Contractor's Name �"� G�fiG ✓ ' Phone. Installation will serve: Residence Z?-`Xpartment House ❑ Commercial ❑ Trailer Court ❑ Motel 0-.,Other ❑ Number of living units. __/-- Number of bedrooms.?__ Number of baths _ Lot size _-70 .ey-f ------------------------------ Water Supply: Public system Community system ❑ Private ❑ Depth}to Water Table APft. i Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe R��ardpan ❑ Previous Application Made: (If es,date-----____--- -,) No 4 pp yNew Construction: Yes �lo ❑ FHA/VA. Yes �No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within4200 feet..) _ t Septic Tank: Distance from nearest well-_,�-- Distance from foundation--.A9------.Mater al_.��_ �� -------- � No. of compartments___� ---__£._..._-__Sue. l�� Iquid depth_._. .1 ......Capacity_ Z� �. Disposal Field: Distance from nearest well -_--= Distance from foundation---ZAP--------.Distance to nearest lot line__v1_1__`_____ i Number of lines,_________ ______- _ Length of each line__ t '._..__ . ------Width of trench.P2_.r.... ------------------- y____.. Depth of filter material--- ---------Total length... > ._____..___________.. V Type of filter meterial.__� De p Seepage Pit: Distance to nearest well------__ ____ Distance from fo dation__ a��/ .� _--- �_,�_._._.Djsta�e to nearest lot L•sne________________ � Number of pits._�.A_____________Linin material---/ ?V �a% �7� Lining ----- - - ------Size: Diameter------------ _--Depthr� __/-;Z�.,r' + Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material--_--___----------------.-____------ D ❑ Size: Diameter..:1.... --------Depth---------------- -----------------------------------Liquid Capacity -------gals. I Privy: Distance from riearesf well----------_-----_------------------- -----------Distance from nearest building.__._____.________.___________-_-_-__�'-. l ❑ Distance to nearest lot line-- -------------------------- -----------------•---- Remodeling and/or repairing (describe):------ '7'?U--0 ..... -4 - -------------------•--..--------------------------- ---- ---------••------------------------- j-------•---------------------------------------------------------------------------------------`---_ ' -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------:---------------- I hereby certify that I have4'prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. k. r (Signed)---------------------------------- ---- - E=-� -- - --- ----- - --- -- --------- ------- ---- ------------------------------- -------------4 wn -dm�or Contractor) By:-----------------------------------• ... --(Title)-- - C� a� (Plot plan, showing size of lot, location of system in r ion to wells, buildings, etc., can be placed on reverse side). f J FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------- --------------------------------------------------- DATE____ REVIEWED BY -- ---------------------------------------- -------------- DATE BUILDING PERMIT ISSUED--.--•---------------------------------------------------------------------------------------------- DATE--------------------------------- ----------------- Alterations and/or recd ndations------------------------------------- -�-- '�z� 9� -------------- '.-------------------------- -� . ��- - --_ - - ------------------------------- - ------------------ .. ' � . ------------------------------------- ------ ----------- :. ----------- FINAL INSPECTION BY--- ------------ --------------------------------------- Date--- - ---- t SAN JOAQUIN LOCAL HEALTH DISTRICT ` 1 , + 1 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi, California Manteca,California Tracy,California F.P.CO.