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FOR OFFICE USE: ------------- ____ _________ ______________________________________ APPLICATION FOR SANITATION PERMIT Permit No. -------------------------------------------------------- (Complete in Duplicate) Date Issued ` � ----------------------------------------------------------- This Permit Expires 1 Year From Date Issued /)-/,-j,� : lC—1-/ ,- - Application is hereby made to the San Joaquin Local Health District for a permi to construct an install t work herein scrbed. This application,is.made incompliance with County Ordinance No. 549. ®-n. CC'° / fsr JOB ADDRESS AND LOCATION__ __fi_/_.... 1{___� Q3_--- k �.. Owner's Name--------- f L. .. � --------------------------- - -------- Phone--------------------- Address------------------••---•/I-70--------/1"fop"I Contractor's Name------ F4r��_ f .._----------------- Phone --- Installation will serve: Residence x Apartment House ❑ Commercial p Trailer Court [j Motel ❑ Other ❑ Number of living units: ___1___ Number of bedrooms ----/- Number of baths ----/-- Lot size -----;45'� X-AOL!_______________________ Water Supply: Public system/El Communif.y system ❑ PrivateE] m E] ❑Depth to Water Table �rVft. Character of soil to a dep+k of'3 fee+: Sand e❑ Gravel E] dy L Sanoam Clay LoaClay Adobe xHardpan E] f. Previous Application Made: (If yes,date......... -........-) No New Construction: Yes No ❑ FHA/VA: Yes ❑ No� „ TYPE OF INSTALLATION AND SPECIFICATIONS: (Noseptic tank or cesspool permitted if public sewer is available within 200 feet.) ;. Septic Tank: Distance from nearest well-t_r&*.....Distance from foundation-___f0.......Mater�pl____C , lgeo� �_�_____________ p �-------Size_r. .lC: IC----�f"------Liquid depth------ y --------Capacity-._A— No. of compartments Z-- Disposal Field: Distance from nearest well---tO."V..._'._Distance from foundation._-_-. _j--_ s ;�_ } _ jot line__s� --p Number of lines____ _ _ __________________Length of each line___'______ ---_ � Distance to nearest I .+ b --- I s -Width of ti"enci .-- ,2.`� Type of filter material__ 4eAff .Depth of filter materiat___--- �-.___..Total length_________________________�G!-'_-__ ` p S:r _�_-Distance to nearest lot line____ �_�_ See e Pit: Distance to nearest well.-'/w___...__=Distance from oundafion___.. a , Number of its-------_ -_ - p' ________.Lining matenal_* r__.___._: ize: Diameter_______--' ...__Depth_._:_-__-_�� Cesspool. _ ool. Distance from nearest well______________ _Distance from foundation--------------.___ .Lini _ _ ng material__.__.__- __-_----.- -____.___'._._ Size: Diameter----- ---------------------------------De th------------------ --------- -------------------..Liquid Capacity---------------------------galsf Privy: Distance from nearest well-------------------------------------------------- from nearest- building--------»:-r-____________------.-. ❑ Distance to nearest lot lire----------------- --------- ------- -------- - ------------------------------- I --------------------- 1 Remodeling a d/or repairing (describe):----- --------------------------------------------------- a�ee,.�- ------------------------------------ --------------------------------------------------------- -------------- --;: a 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 and regulations of the San Joaquin Local Health District. ., .. t . I (Signed)--------- - --------- -- -- -----------------------------------f---------f --------(OwnerA and/or Contractor) By:-------------------- a - t------ --------- -------------------------(Title)-------------------------------- -- ..---------- . w (Plot plan, showing size of lot, location of system in elation to wells, buildings, etc., can be placed on reverse side). i FORD RTMENT USE ONLY Of APPLICATION ACCEPTED BY---- = ---- DATE----- REVIEWED BY-------------------------I----- -- -- (�`------- - -------------------------- DATE----------- BUILDING PERMIT ISSUED--- -------------- ---------- - DATE------------------ Alterations and/or recom endations--- ="' l = a t r� j'" s r t --- ----- ------------------------------ ------------------- _. -- - --- ------- <�4 `. f4. ..... E .sae t- 05 -------------------------------------I------ ------ ------------a----- ---------- FINAL INSPECTION BY:------------ -- -- - - - -- - - --- Date.......1.__d-_' --� ---- ---- -- QUIN LOCAL HEALTH DISTRICT 1601 E.Haielton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California — Manteca,California Traryr California F.P.CO. r