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FOR OFFICE USE: ll ----- - Permit No. APPLICATION FOR SANITATION PERMIT --- (Complete in Duplicate) Date Issued ._�-. .1 -4d _"- -"__ 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 descri e . This application is made in compliance with County Ordinance No. S49. 5 +3` --------------- ----•-----•------------------•--- •--------- JOB ADDRESS AND LOCATION------ ---------- Owner's Name- 'l l "" -----•-----C- _01Z"±AM----------- - - --------------- )Address---------------------------(----5 -C ----------==�=------------------------------------- Contractor's •----------•-- c ----------------------- e"-.��"�,`�--�---------- --------------------- Contractor.s Name--- -- -------------- -------- - GPhon Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: --- Number of bedrooms _3"-- Number of baths - " Lot size .__I S=O'.--.X--l�S-=Q--'----------------- ""(. Z- ---- Water Supply: Public system [I Community system ❑ Private Depth to Water Table -6-0- ft. Character of soil to a depth of 3 feet: Sand E] Gravel ❑ Sandy Loam [IClay Loam ❑ Clay E] Adobe X Hardpan ❑No� Previous Application Made: (It yes date__"-----------------) No New Construction: Yes E] Nox FHA/VA: Yes ❑ ' 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_------------.---_.Materia------ ----_-----------.._________---------___-- ❑ No. of compartments. Size------•-------------------------Liquid depth---------- --------------Capacity--•-------------------- Disposal Field: Distance from nearest well...�`�� "---"Distance from foundation-----S�_�___._--Distance to nearest lot line_""_ •o( C7(IbTl1f Number of lines-------------j------------------- Length of each line------I-n`1- --------:----Width of trench----------IS-----------,-------- !�a -r0- j� Type of filter material"S,_S�AgAC.._Depth of filter fS� _"""-_Total length00"_-_" oundation--------------------Distance to nearest lot line----".--_"_ I Seepage Pit: Nummbe of ptto s rest well-T-- Linin material -- from f------ Size: Diameter------------------- ---Depth------.--.----------------------- ❑ g Cesspool: Distance from nearest well--------------_-Distance from foundation--------------------Lining material------------------------------------- OQ ❑ Size: Diameter------------------------------ -------Depth------------- --------------------------------------Liquid Capacity---------------------------gals. Privy: Distance from, nearest well--_-...---""--_"---- Distance from nearest building--------------------------------- ------- ❑ Distance to nearest lot line-------- -----------------'----------------------- "S ICI Remodeling and/or repairing (describe):---___- - D- .......... -------------`- I 6_T-1 J1L- ------------ 5__1-��??----•----// ► -------------- ,S+ ,�y T �----- - ----- ----- ----------_he---------- - ----- ------ --ha -- P p pp ,. q y I hereby certify that'l have repar 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. t ---------" (Owner and/or Contractor] 5� - ------ ---------- ------------------------------------------------------ ----------------------------------------St ned - -- - -- - ------ By:----------- -------------(Title)------------- ------------------------ ----------------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side]. FOR DEPARTMENT USE ONLY / --- DATE-------- ---�� -��-------- ---------------- APPLICATION ACCEPTED BY_----------- -------- �----------- DATE --- --------------------------------- REVIEWEDBY----------------i----------------.------ ------------------------------------------------------------- DATE------------------------------------------------------------ BUILDING PERMIT ISSUED------------------- --------- - ------ --------- � Alterations and/or recommendations------------ ------- - -------------------------------------------------•-----•---------- ----------------- ------- --------------- ------ --------- --- ------------ ----------------------- ------------------------ ---------------------------------------------------- _ - -- -- Date-- --- `�---��-------� -- --- - ---- ---------- -------- FINAL INSPECTION BY:.. ---- -- ---------`1--------"--- - 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.Co.