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FOR OFFICE USE: ------------------------- Permit No. APPLICATION FOR SANITATION PERMIT --------------------- - �..-- (Complete in Duplicate) w.g 'Date issued _--;.. This Permit Ex Irish Ye7hr From Date Issued —----——-- ------——- q p Application is hereby made to the San Joaquin.Local Health District for permit to construct and install the work herein described. I This application is made in c;om ane with County Ordinance No. S49. c A}" Y�TC>t w JOB ADDRESS AN /LOCATI p ---------------------------- � [j -----------11 � �� '�.` Owner's Name----------------- j l ------- - ------ �_�4ER5------ ---- ------------------------------------ Phone------------------------------------ � -G.) Address ------ ----•- -----------------5-1-1--N---- a Contractor's Name-- ----- -- - --1 L Phone... Installation will serve: Residence ®/Apartment House ❑ Commercial ❑„ Trailer Court ❑ Motel ❑ Ofiher ❑ I ------ f --- Number of living uniti�: __(---- Number of bedrooms _=Number of baths./--..__ Lot size . Water Supply: Public systelrn ❑ Community system ❑ Private �epth to Water Table _A,?__�ft. Character of soil to a depth of 3 feet: Sand Gravel ❑ Sandy Loam ❑ Clay Loam ❑ - Clay ❑ Adobe ❑ Hardpan ❑� - Previous-.ApplicationwMade:1(If yes,date_7:- 1-):,-No-El'-'* New;Construcfion:_Yes-O=No-©=�FHA/VA:Yes El—No,�- TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic nk: Distance from nearest well---:SO --.Distance from foundation_.4-�.�.-------- _Materi L ' _ ----- No. of compartments......�z�------ .Size.-_.X--�_ --S---------Liquid depth--- __. -------.Capaaty___ __---- Disposal Field: Distance from nearest well_._ti�?. ,;__.Distance from foundation---- _,_-_--.Distance to nearest log li%`--------------- D j ©� Number of lines.._..--.- __.- Length of each line--S7 1 _--.Width of trench..-__�y...._---------------- S Type ofI filter material__�.0.C-K----Depth of filter material-___!_.-�_�_--.-.To#al length-------l ----- _.- Seepage Pit: Distance to nearest well----------------------Distance from foundation....................Distance to nearest lot line-...___------.... ❑ Number I umbeiI of pits------- ------ -------Lining material------------- --------Size: Diameter--------------..........Depth----------- --------------------- C Cesspool: Distance from nearest well-----------------Distance from foundation.-..-__.------------Lining material------------------------------------- Size: Dilb meter------- - - --- - ------- ------Depth----- - ----------- ----- - -- ------------------Liquid Capacity- --------------------------gals. Privy: Distance from nearest well-------- ------- --•------•--------------------Distance from nearest building-- 9. ❑ Distance to nearest lot line ------------------------------- -------------------------------------------------------------------------------------- Remodelin and/ pairs describe --- _ F.).--------�� vEk _[ZQ4�--------7-.�/�1��-.��, • M[V_tE -- 0 � g or re g [ � PRP-ms > -R CTS•)------� ------ * t�T t -------------------------==------------ ----=------•-------•------------------------------------------------------------------------ ------------- ----- -------------------------------------- --------------- 11 1 hereby certify that I'jhave 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. M '(Signed)-� 'G� '""` I'�� r f' �`� �--------------------- ------------------- :-:-{Owner and/or Contractor! 1 } (Title)---------- .- ------- -------- Y------------------------------------------- (Plot -----.•-•-•-------•-------------------•- (Plot plan, showing size of I{t, location of system in .relation to wells, buildings, etc., can be placed on reverse side). FOR.DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------- .....I.A� R_ Q----------------------- �`'- ------ DATE---------- -7-4 - � --------------- REVIEWED BY------------- ';;-------- -. - DATE BUILDINGPERMIT ISSUED----------------'---------------------------------------------------------------------------------- DATE----- --------------------------- ------------------------- I. Alterations and/or recommendations:_----------- ------_---------------------•----------------------------------------•-•----------- ---------•-------•-------------- ----------- ---------------- ---------------------------------------------------------------------------------------•-----•------------- -- -------------------------------- ------ .-- . ' ----- - -------------- ---------- --------------------------•--------------------- ----- ------------------- - FINAL INSPECTt@A_.V- �7 Date------------------7_ /__ 71�- ----------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9Th Street Stockton,Californial Lodi,California Manteca,California Tracy,California F.r=.❑Q.