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FOR OFFICE USE: 2_ APPLICATION FOR SANITATION PERMIT , Permit No. -------------------------------------------------------- ---------------------- --------------- = -C) (Comp�a in Duplicate) Date Issued ------------_--_---------_ ----------------------- -_. This Permit Ex ir' f, Year From Date Issued r 17 C-,(- D--fD Application is hereby made to the San Joaquin Local Health District for a permit tp construct and install the wgrk herein described. ,T.his-ap Goation�is-made,in.cores liance with County Ordinance No. 549. �(/ , ��r�9v �-I7,0k � � '��chit=r��"-� r JOB ADDRESS ANQ LOCATION: -Xr�" 'l �� dG'__1�� ------- Owner's Name- --------------------------------- Phone------------------------------------ Address--- '�= / ��'�� ---- Contractor's Name--------xe_ 7 —--------------------------------------------------------------------------•-------- Phone----------------------------------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ i Number of living units: Y_- Number of bedrooms _ _ Number of baths A--- Lot size tg.9�`G ----__---------------------------- Wafer SuPPIY� Publics stem ❑ CommunitY system ❑ Private ( e th to Water Table lft --",j � Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan Previous Application Made: Ilf yes,date--------------------) No JR, New Construction: Yes'[�No ❑ FHA/VA: Yes P—No ) TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.)� E .01 L, Septic Tank: Distance from nearest well_`1 �.._Distance from��oundation_� __._____.Mafe'ale__l/ .-__ ___.___ /__-__-__-_.�� No. of compartments._¢.�----------SizeAdX_ _______________Liquid deptl>✓'.;�_../ni _�apacity _____/1AL l-1 Disposal Field: Distance from nearest well./Ar Distance from foundti aon__ - ______.._.Distance to nearest lot line_J?� (� Number of lines___.__ ___ _ r��• �- Length of each line_� --- �. --- _ width of trench_ Type of filter materia W-4 ...._Depth of filter material_ZO_.__......... Total length. ______ ------ ---------- ___�____ ff E f' Seepage Pi Distance to nearest well��o___-..______Distance JffWm fo ndation. Q_____._-- Distance to nearest lot - / Number of pits---- Lining material_.�R __-Size: Diameter�� _ --------Dept e l Cesspool: Distance from nearest well_________________Distance from foundation-------------------.Lining material-_-_..-----_ ---_----------�� El Size: Diameter----- -------------------------------Depth---------------------------------- -----------------Liquid Capacity---------------------------gals. x Privy: Distance from nearest well------------------------___-----------:------.---Distance from nearest building.____...__-_-_-________-_____.__--.____. ❑ Distance to nearest lot line----- ------------------------------- -- ------------ ------------------J----------- ----- -------------------------------- Remodeling and/or repairing (describe):__., - ------------- --------- -------------- ------- ---------------- - - -------------------------------------------------------------------------------------------- ------------------------------- ---- --------------- ------ -------------------------- --------- ------------- - -� oa ----------------- --------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------- 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. `. -� �, � .. r Contractor) (Signed)--------------------------- �-�-L-u-- - - �,��li.��- - ---------------------- ----------------------------- ----- � ) By:-------------------------------------------------------------------------------------- (Title)----l:� ` /G '------ ----- - (Plot plan, showing size of lot, location of system in relati o wells, buildings, efc., can be placed on reverse side). ! FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----------------- --------------------------------- DATE------. - � Gil_------------------- t REVIEWEDBY----------------------------------------- -- ------------ -------------------------------------------- DATE----------------- ----------------------------------------- BUILDINGPERMIT ISSUED------------- ---------------------------^----------rte r-------------------- DATE-----------------------------------A---------------------;. Alterations and/or recommendations:--------1--)--- -� c� + '_ IfS ---- �C'"t- --1.(-------------- ---------------- ----------------------------------- --------- ------------------------------------------------------------- -------------------------------------------------------------------------------------------------------- -----•------------------------------------------- ---------------------------------------•----------------- ------------------------- - ------------------------------ I �� Date �3 -�----�--------�---�--- ------------------------- FINAL INSPECTION BY:- Date------------- -------------------------------- S N JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazolion Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.CO.