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FOR OFFICE USE: _ g APPLICATION FOR SANITATION PERMIT Permit No. 1----- _-- (Complete in Duplicate) ------ -- ------- ��. Date Issued ------f ��-� _ ___.____._---.-__ 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 described. This application is made in compliance with County Ordinance No. 549. r1, JOB ADDRESS AND LOCATION....--- -----�-l.-=:;--- - �� -- ---T�- -�-=�----`---------16 - tlu�''e •---AOwner's Name-----------8-/---, ------- l---------;,4-- P.� `---_ Z-------------------- Phone- �-,e 13----- Address----------------------- ddress--------------•-------- Lr)-------5-,_------- ---- ----------------------------------••----------...--------------------------------------------•------- Contractor's Name-------- ie � /�j-------- ------------------------------ •-------------- ---------------- Phone_ /_---?669.7 . Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑''' Other ❑ Number of living units: --- Number of bedrooms ---/--- Number of baths __/--- Lot size _____,/ � t - r -------------------- Water Supply: Public system ❑ Community'systein ❑ Private 10 Depth to Water Table ft. Character of soil to a depth-of 3 feet:, Sand ❑ Gravel ❑ Sandy Loam N. Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ tet' Previous Application Made: (If yes,dote?-------------- ----) .No New Construction: Yes ® No ❑ FNA/VA: Yes ❑ No Pq 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_.__?P.Q___Disfance from foundation__/-5___/---.-.Material_. ,e_ No. of compartments--------15------------Size_ �_ -5------Liquid depth_..-_,-53..'y--------Capacity------------4Q �- Disposal Field: Distance from nearest well._ i,�!.._._Disfance from foundation-- -------- ._-.Distance to nearest lot lineZ4f._t Number of lines---------- 3- ----------------Length of each line_._�'C2___--__.______.Width of trench----�f `Y_-__.______--._ t . '—Type of filter material.- .C46��[.__Depth of filter material_._ : -------Total length------r--;Q_-`------------------ T y, Seepage Pit: Distance to nearest'well- ------------------Distance from foundation_--_-_.----------- Distance to nearest lot line__.--_-.--_-_._-- ❑ Number of pits------- --,_,-,;.Lining material------- Diameter-----------------------Depth-...----------------------------- Cesspool: Distance from nearest well':---___'------Distance from foundation--- ----------------Lining material-----------------.-----.--_--_.__-_.-. ❑ Size: Diameter--------------------------- - ----'--,.Depth----------------------------------------------------Liquid Capacity-- -------------------------gals. I Privy: Distance from nearest well_...__-.-___._.____----------------------------Distance from nearest building_-_--_--_.__-_.-____-______._.......... [] Distance to nearest lot line - -------- ------------------------------- ---------------------------------------------------------------------------------------------- Remodeling and/or repairing (describe]:__. iv, _r �/----- � _ '! -a3'I" . 7--- :-• --1/.rll ----------- it-,c --------..��-----. �°�f �u ------------------------------ --------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------=------------------------------------------------------------------------------------------------------ I hereby certify that I have prepared this application and that the, ork will be done in accordance with San Joaquin County , I ordinances, State laws and rules and regulations of the San Joaquin Local Health District. 1V l —.�= - ------------------------------------ (Ow rand/or Contractor (Signed) r r ------------ gY: uhf - _ ------------------------------------------------ [Title} f (Plot plan, showing size of lot, Iota ' of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY 64 APPLICATION ACCEPTED BY_. ._ -- ------------------- DATE 1 __-----_.__- . --------------------------------- REVIEWED ____. __ .p._. ._ .___ ______________________________________ _._.._.________._______._._ REVIEWEDBY..----------------------------------------- ---------------- --------------R-------------------------------------------- DATE--A--- --------- --•--•------------------ ----------------- BUILDING PERMIT ISSUED------------------------------------------------------ -------' " - :.�_��.' -D-ATE:_-=-�--------------------- - Alterations and/or recommendations---------------- ------ -- - --------------------------------------------------•---------------------------------------•--------------------------------------- -------------- ------------------------------- ------------------------------------------------------------------------------ ----------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------- --------------- --------------------------- - --- --------- ------------------- ---------------------- -------------- / FINAL INSPECTION BY. .- � -------------------------�� Date---`Z �� P-/------ --- -------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California • F.P.CC. -