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FOR Or.—ICE USE: 9 .. -_r` JJ / _ _ __________________________ _ _ APPLICATION FOR SANITATION PERMIT Permit Na ____________ __ ___ ____ ______ . l • �/._ --------------------------------------------------------- (Complete in Duplicate) 3 ------------------------------------------------------ This Permit Expires 1 Year From Date Issued Date Issued Application is hereby made to the San Joaquin Local Healfh District for a permit to construct and install the work herein de cribed. This application is made in compliance with County Ordinance No. 549. gJ B ADDRESS AND'LO ATION__ _ ------- _��(,�J_;._-_-! ___I/ r__ _. _ _ ` - Owner's Name---- �'' Phone- Address--••--- -------- ---------.-- ------- ------ -------------------------------- ------•--- _---•------------- Contractor's Nam _-N___- ''F dt_4-j- r±~C�� Phone ?_�2" Installation will serve: Residence partmen House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __ ___ Number of bedroom /� r __-- Number of baths -- ----�.L•ot size ---- ---- ----------�.-�-�:�-----------.- i Water Supply: Public system ❑ Community system ❑ Private Depth to ater Table -------- ft, I Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: {lf yes,date....................) No ❑ New Construction: Yesto ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: " '(No septic-fa nk'or cesspool permitted-if-pu .'c sewer is available within 200 feet.) Septic Tank Distance from nearest well Q_ .____Distance fro foun ation__�.42______._.Material__ ' [t _ No. of compartments--2-------------------Siz �7l+_ _ iquid depth_ _�f----------- Cap acity___.J--�_�` Dispo al Fi Distance from near t well g r�� ---1' � ____--__-- , �__ __Distance from foundation______________ Distance to nearest line_ -- {O- a Number of lines____ Len th of each line-�b -Kee> Width of trench- �/� -•D Type of filter material �t Depth of filter material__l f�______-Total length__________________________________________ 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 we31_________________Distance from foundation--------------.-----Lining material__._..._______._____.__.___.____..___. ❑ Size: Diameter--------------------------------------Depth----------------------------- ----------------------Liquid Capacity-----------------------------gals. Privy: Distance from nearest well-------------------------------------- ----------Distance from nearest building_-__._____._________.________..__..____._. ❑ Distance to nearest lot kne-- -------------------------------------------------- --------------------------------------- Remodeling and/or repairing (describe):__._37j.777- ---------R-EC:<?MMA� t>--------/.2,PP----GA --'tet? Jed -----------•------ •--------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------- --- ------------------------------------------------------------------ -------------------------------- ti � l ------------------------------------------------------------------------------------------------ .. I hereby certify a+ I h ve prepared this application d that +he work will be one in accordance with San Joaquin County 'ordinanc�Staws anrules and ulatians of the n Joaq in cal thstrictQ E 1 (Signed) �i�'/ r*� -- [ r Contractor) ------------- By:----------------------------------------------------------------------------------------- ------ ----Title)-- ------------ --- -------- - -------- --------- --- -- ------ -(Plot'plan,showing size of lot, location of system,in relation wells, buildings, et ., can--be placed om reverse side). +I '�— FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--- T---t-R---------- ---------------------------------------- DATE-------3 7717 R- -------------- REVIEWEDBY------------------------------------- -------------------------------------------- ------------------------------------------ DATE------------------------------------------------------------ BUILDING PERMIT ISSUED------------------------------------------- ---------------------------------------------------------- DA-TE----------------------------------------- ------------------- Alterations and/or recommendations_______________________ _ ------------------------------------------------- .......... -------------------- ------------ ------- -------- ------------------------------------------------------------- - -------------- -- ------------- -----------1--- -------- ----------- ------------------------------------------------------------------------------------------------------------- R 0 FINAL INSPECTI T � Date--------------- -A b�� SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Ha:ellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ' F.P.c o. —