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FOR OFFICE USE. _-�.- ---------- ------------- >--------- i_? �` --------------------------------------------------------- APPLICATION F k SANITATION PERMIT Permit No. -_4P2.2:.-K.-5 ------------y -1------------------ ---------- (Complete in Duplicate) -� Date Issued ------------------____________ ----- _ _ ----- --------- _ is 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. JOB ADDRESS AND LOCATION 1- r--------- < f - Owner's Name 1!J'Jzr - -------- Phone---------------------------------- Address---------------- -- - ""`- — _- . .. . ------------------- --- -- r_ Contractor's Name. ----- ! { �� t-�'�M�� t'�.t_� � ---- - --------- ------ --- - Phone..!- " -'- �'� Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other Number of living units: -------- Number of bedrooms _______ Number of baths ______ Lot size --------- Water .-.___Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table _Y ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe D-'Hardpan ❑ Previous Application Made: (If yes,date_.-------.--------- ) No [9---New Construction: Yes �o ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Cf (/ V\ Septic Tank: Distance from nearest well_ _ __ _Distance from foundation-.1��.-- Material__.. _P No. of compartments___,_.__ ----------- _ ----------Liquid depth__.-.. ------ --------Capacity..�(E'�_- �/ Disposal Field: Distance from nearestwell-well-5?f__ _._Distance from foundation--//_ .____.Distance to nearest lot line--------_ Number of lines_____.!__.--�__ Length of each line_____ /__`______-___.Width of trench____-_%---_.._______-_ Type of filter material_?>_ �` Ftc_l`J_Depth of filter material_.__`.�_�--_____Total length_-__- G_'___..______..._____.._ Seepage Pit: Distance to nearest well_ C! _:__.f_Distanc, m foundation-5 ./-------Distance to nearest lot line---- Number ___Number of pits------ -------- .-Lining materia -Size: Diameter___ _��_______Depth____ _ `_---____._____.- Cesspool: Distance from nearest well ----------------Distance from foundation--- ----------------Lining material__-____.___._-.__.________________. [] Size: Diameter-- -------------- ---------------Depth--------------- --------------------------------._Liquid Capacity---------------------------gal Privy: Distance from nearest well----------------------------------------------__Distance from nearest building------------------------------------------ 1771 .____-_.____________-_.❑ Distance to nearest lot line----- -------------------------- --------- ----------------------------------------------------------- ---------------------------- Remodeling and/or repairing (describe):------- . :__z, -------------------------------------------1-i` ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ----------- ------------------------------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------- -------------- ---- -- -- ----- ---- ----------------------------------------------.------------------------------------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, to laws, and rules and re lations of the San Jo ,quin Local Health District. (Signed) - 'iFf--------------- - (Ow, er and/or Contractor) - - - f f — � / -------------------------------------------- ---------------� �...------(Title) l I'�(/Z (Plot plan, showing size of lot, location of system in relation to wells, uildings, etc., can be placed on reverse side). E O DEPARTMENT USE ONLY fFP APPLICATION ACCEPTED BY------ - + ---------------------------------- DATE------3_`7-`'--- REVIEWEDBY---------------------------------- - - ------------------- -----------------._.- DATE----__--------------------------------------------------- BUILDINGPERMIT ISSUED - = - •----- --------------------- ------------------------. DATE--------------- ------------------------------------------- Alterations and/or recomendations:-------:-------------------- ------------------ '7------------------------------------------------------------------------------------------------- , -- - -- f - ----- - --------------- ------------------ -------- IX. ---------------------- — ---- ------ - • -------- -------------------------------------------- ----------------------- ------- -6 - ,=----------- --urIf------- �Ak------ �, - - ------------------------------------------------ ------------------------------------------------- FINAL INSPECTION BY:----- - - -------------------- Date._.Y-=-f=07----------------- --------------------- SAN,lOAQUIN 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.