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F R OFFICE USE: / APPLICATION FOR SANITATION PERMIT Permit No. _.. ._ __ _ i -----__--- [Compete .-__��,'_v ,�. lin Duplicate) Date Issued _-------------P-Llf --- This Permit Expires 1 Year From Date Issued F 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 ��--~-4"I.7 /---- ----- ----------------------------�- --------------------- _ Owner's Name---- 4..2,.1-- - - , --- ------------------------------------ Phone .� / �= --- --------- Address------•` L c. �� ' -t�?r__ %� ��1ct ----- ---------------------- - - ------•---------------------------------------- Contractor's Name------ f�' --------•-------. Phone------------------------------------ Installation ------•----••- ---- - Installation will serve: Residence �K Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ } Number of living units: __!_-- Number of bedrooms 4--- Number of baths __ _-. Lot size _ - 1 ________________ _______________ U' Water Supply- Publics stem Community system Private Depth to Water Table�,7ft. - PP Y� Y IHS Y Y ❑ ❑ P Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam E],,Pey ❑ Adobe ardpan ❑ Previous Application Made: (if yes,date.----------,........) No 5;--- ew Construction: Yes PONo E] FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool._permitted_,if.public_sewer„•is-available.within__200,feet.)_ 1 - - � e f Septic T Distcince from nearest well_-'` --_Distance from foundation ________________.Ma#trial__: __ - ______ --------- No.!of compartments— _ __Size_�a_ - �'___`_____Liquid depth_. l�,------------Capacity__' ___..___ Disposal F' Distance from nearest well_t-�....Distance 'from foundatiop-�--;--------Distance to nearest Int line!_�____�- Nurrlber of lines--------- ---- - � --- ------W�dt Length of each line----__ -- -- of trench---- _____J--------------- Type of filter material-AA - -- = ___ -------f f _ `-.-Total length - ---- - ,. .,: ,: Seepag �itDistance to nearest well__::_.; ._.'. �'Distance f m fou5dation__ .�___�.___.Distance to near lot li77 ne 47.�__---. Num of pits_--_-__ __.--,-__._Lining niatarial__ G ____-Size: Diameter , --- ___Dep+ Distance from nearest well___�_-_.�`eDistance from foundation--_____---_..___-_Lining mate,rial----------_--------------------------- Cesspool: ' ❑ SizeDia'amefer- - -------------- -- ==4;,-1-.---Depth-------------------------------------- ------------- f ----------- Liquid Capacity: gals. Priv Distance from nearest well---------------- -------------------------------Distance from nearest building' _.'-_ -------------------------- -------------------- _x--_---______------.--. ❑ Distance to nearest lot line.-------- - -------------------------------------- •--------- k �f ---,y F ------------- Remodelingand/or re airi describe - ------- ---- - ,�/ �� 1rr f ---------------------------- ----------------------------------------------- --------------; -----------------------------------------------------•-------------------- ----------------------------------------------------------------- --- - --------------------- --------------------------------- ----- I hereby certify that I have prePa ed this application and that the work will be done in accordance with San Joaquin County ordinances, State I. s, nd'rules afions of the San Joaquin Local Health District. I R wr .t ` Si ned 9 ------------------- -------------------------------------------- (Owner r Contractor) 9 /f� Ow and .o for ------------ {Title)L- ---- -- ---- --------- ------ BY:-- - {� = (Plot plan, showing size of I t, to ton of system in relation to wells, buildings, etc., can be placed A reverse side). -i— --�-�--�—�FOR-DEPARTMENT-USE-ONLY----- APPLICATION ACCEPTED BY-- - ------ ---------------------------------------- DATE /-_ ----- --- ----•----- REVIEWEDBY-------- --- -- --------- ------------------------------------------------- ------ --------- DATE BUILDINGPERMIT ISSUED---------•------------------------------------------------------ --------- ------ DATE--------- --------------------------------------------------- Alt ation and/or recommendations:----------------------- ---------------�- --------------------------------------------------------------------------------------------------------------- q �s C+_`!� �,4------------•------------------••-•------- �� -1 -------------------------------------- --. FINALINSPECTION BY:---- = ------------------------------- Date---- /a ----- --------------------- -------- ------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haielton Ave. w 300'West Oak Street E� 114 Sycamore Street 205 West 9th Street i Stockton,California ; �� ^Lodi,California ` o'Si teca,California Tracy,California I F.P.C p.