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FOR OFFICE USE: 1 - - APPLICATION FOR SANITATION PERMITPermit No. .a�/ • --------------------------------------------------------- ----------- ---------------------------------------- ---- (Complete in Duplicate) � -- This Permit Expires I Year From Date Issued Date Issued �C__ _ 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. q.3--100 -Z7 i. .�7•f.d j s. ii<C� -.C-�.5�'..•'•, rr� ,•� Fj / E�cuaQo JOB ADDRESS AND LOCATION- -----�1-----�%n-"f--- -------------- ` ------------------/------------------------- /v�2G'Hf30/f �O .s�72ve77Gt� CSO. ` • ��%' - _ Owner's Name----------------•-------------------------- ----- --------------------------- _/------------ ------ S / t7 u .�1 C�2/-1_M.�rvT........., ems'`-/ >�,>_ ` f-------- .................. Address-----�` kI--1------��_C!�Q.__/Z -.�__e'D------ - - --- / Contractor's Name IZT/N �� .W - .._' viC• ------------- Phone----/]�L� ` Z w Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other Number of living units: -------- Number of bedrooms -------- Number of baths -------- Lot'size ____)00'Y' :3wO,---- ----------------- - Water Supply: Public system' ❑ Community system ❑ Private X Depth to Water Table ------ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam 0 Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (If yes date-..___._.--_------_) No o New Construction: Yes N No ❑ FHA/VA: Yes ❑ No,q TYPE OF INSTALLATION AND— SPECIFICATIONS-(No septic tank or cesspool permitted if public sewer is available within 200 feet.) . / � � �NfieE-TE Septic Tank: Distance from nearest well_�w_'--Distance from foundation__,. ------Materiak------------_------------ -------------------- No. of comparfiments._._.�L'VQ........Size__?..-X-5.-xA,----Liquid depth-----`71 ---_----------Capacity.__.__ Disposal Field: Distance from nearest well_.._S Distance from foundation--_._ _.--._Distance to nearest lot line----s---._.� � Number of Tines___-______�.:�._._��__."_�_____Length of each line-------- =___Width of trench_----v? ____f_______________ Type of filter materiai-__ lC__.Depth of filter material_____ --------Total' length__ ------,'QQ------------------- � Seepage Pit: Distance to nearest well----------------------Distance from foundation------...-----------Distance to nearest lot line.__--_____---__ ❑ Number of pits----------------------Lining material---------------_-----Size: Diameter-----------------------Depth_.-._...___________--.---------- Cesspool; Distance from nearest well-------------- Distance from foundation_______________ Lining material..........,._.-----------.---------- . ---------Depth-..-----•---------------------- ------------------.Liquid Capacity---------------------------gals. {, Priv r -D stance fromnearest we"IL-------------------__-----._------------------Distance from nearest building--------------- __,____._______-----------. Distanceto nearest lot line----------------------------------- -----------=------------------•------------------=------...----- ------- ------------------- Remodeling and/or repairing (describe):_.._. ------------ ++ ------•------------------------------ ---------------1----- ----------------------- ----------------------- -- —------------ - I ---- ------- I hereby certify 4hat 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. 1 - Lv (Signed)----C--1e.T 1 -- _ �iZl2(JI_C _______________----------------------------------------- Owner and/or Contractor =1�1� `� g --- ................ --------- Y:-------------- -- - ------- - -- - y--------------•----------------- `(Title)__ ' (Plot plan, showing size of lot, ocation em in relation to wells, build ings,,'etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED.BY---cam -. -- -�----------- - ----- --------------------------------------,.DATE1-------4&/—A------•----------- ------------- r REVIEWEDBY--------------------------- ---------_ ------_ -- DATE---------------------------------------- l BUILDING PERMIT ISSUED------------------- DATE.- a---------------- ------ Alterations and/or recommendations:---------- - --------------------------- -------------------- = ------------------------------------------------- --------------------------------------- FINAL INSPECTION BY:. -----------•---------------- Date..../� f`r----_4 ---- --------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 160.1 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.CO..