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F FOR OFFICE USE: �- ------- _ a 3n. APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) Date Issued _-------------------_.---____---.--_____..___._.___ This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein descried. This application is made in compliance.with County Ordinance No. 549. 1 i JOBADDRESS AND LO AT;ION---------- �,. ---------Z d_1------- -------------------------------------- ---------------------------------------------------- ��p G -----=-------------- Phone----------- ------------------ Owner s Name-------------- -�-�._�`J ..--�-/- ------------ - - ---------= -------- - - x e , ,Address-----__ --------- -- ---- -•-- im ----• ---------------------- ' , ---- # ------------- Phone-------- --------------•-•--------- Contractor s Name--- -- ------)_ Installation will serve: Residence UXApartme-nt House ❑ Commercial ❑ Trailer Courtl❑ Motel ❑ Other ❑ Number of living units: ___1-- Number of bedrooms',---- Number of baths _/____ Lot size --.1—ru------------- Water Supply: Public systemmunity system E] Private E] Depth to Wafter Tableis-ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam Q Clay [I Adobe ® ardpan ❑ Previous Application Made: (if yes,idate._-----------------1 No L?�New Construction: Yes ❑ No Q,,1F9'A/VA: Yes ❑ No Z]-,-- TYPE OF INSTALLATION AND SPECIFICATIONS: " (No septic tank or cesspool permitted: if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well-______-____----Distance from foundation.-__._.____-___.P aterial_________________ ------------------------------- No of compartments------------------------Size------- Liquid depth- -#- Capacity Disposal Field: Distance from nearest well__________________Distance from foundation________.___---._- 1Distante to nearest lot line__.___-_.________ F ,IS 7/r� Number of lines----------------------------------Length of each line-----------------------------!Width of trench....- --------------------------- k Type of filter material_________ _____ _______Depth of filter material------------__--__.___-iota) length_____.___--_____:____--_________.___.._ M Seepag it: Distance to nearest well--- �r! Distance�fro�m1 foundation__�C� ----- Distance to nearest lot line-~� _____ dumber of pits_..._(____---______-Lining materiaMack-----------Size: Diameter., ..f_�---.___.Depth_: Z f (3eSs'�oof` J Distance from nearest well_________________Distance from foundation___-_.._.-.-____ _;.Lining material____...__.____.__________._._____.___. yJ Siie: Diameter--=-----------------------------------Depth------ -------------------------------------------!Liquid Capacity------.------------ gals. 1; Privy❑ Distance from nearest well--------_•---------------------------------------Distance from ne gest building..__-.-.__._________---_---__.-------- .00P F-1Distance to nearest'lo line --------------------------------------------�-------------------------=----- --------- -- ---------------------------- ------------- r a - /LCr?-rf�. Lrf-,-- ----- •---. .G Remodeling and/or repairing {describe):__... ,TL, f { k ---- ----------------------------------------------------- ------- - - GOP ---------------------------------------------------- I -------- -----------------'-------------------- I hereby certify that I have prepared this application and that the work will be done in raccordance with San Joaquin County ordinances, State ws, and rules arid regulations of the San Joaquin Local Health District. i 1 � (Signed)----------- '--- ------- ------- ----------------------------------------------' (Owner and/or Contractor) )n�e�6 - (Plot plan, showing siz ot, location of system in relation to wells, buildings, etc., can be placed on reverse side). t FOR DEPARTMENT USE ONLY I ' dt APPLICATIONACCEPTED BY------ -- ----------------------------- ----------------------- DATE -- •------------------------ tREVIEWED BY------------------------------------------- - --------------------------------------------- ----------------------------- DATE------------- ---------------------- ---------------------- BUILDING PERMIT ISSUED------------- ----- --------------------------- DATE r r pn /or recommendations:.____ - --r--------- = ----------------- Alterations �'L/G' `�c !�� ------------------------------------------------------ ------------------------ - --- ------ ------ - ------------------------------ --•--------------------------------------' ---------------------------------------------------------- ----------------------------------------- ------------------------------- ----------- ---------------------------------------------------------------- ---- --------------------- ----------------- -------------- - ----- 1 F ------------------_.._-_-N BY _ _FINAL INSPECTIO -----C------- -------------------- Date---- -Z. SAN ._... JOAQUIN LOCAL HEALTH DISTRICT 1681 E.Maseltan Ave. 300 West Oak Street 124 Sycamore Street j 205 West 9th Street Stockton,California Lodi,California 1 f Manteca,California Tracy,California F.P.CC. {