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FOR OFFICE USE; � . 3--- -------------- - 6_ -- .��.-- APPLICATION FOR SANITATION PERMIT Permit No. . - a 7 ' -------------- ------- (Complete in Duplicate) 6 Date issued This Permit Expires 1 Year From Date Issued Application is hereby made'to the.San Joaquin�'Local'Healfh District for a permit to constru t and 'in all the wos,k hereln described. This application is made in'compliance with County Ordinance'fNo. 549. /✓�'�� V�/J� -U Z'1 .s7 E . aria �t�. . �.s JOB ADDRESS AND LOCATION - _ SI - , Owner's,Name-- -1 ( ! 1 t ! 1 -Phone r -------------- ------- ---c'... . _� 3� Address. ... -----•---------- ''------------••=--------- yo- Contractors Named _____ _ __ �_ _______ 4h Installation will.serve:) Residence ,--Apartment House( �omm�ercial •� Trailer Court Motelhone.__O__ ______________f. f2=�� S `` �. � p_ g ❑ � ❑ ❑ ❑ Other ❑ Number of iivmg units: __-V _:Num er of bedrooms ___��--Num'or of baths ___..... size __�__ _�__._.�_f'—�-�__'_____��___..__ Water Supply:'•Public system ❑ Community system ❑ Priva+e Depth to Water Table _.44Qft. 5 Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ San y Loam ❑ Clay Loam Clay ❑ Adobe ❑ H Hardpan ❑ Previous Application Made: (If yes,date--------------- ____) No New Construction: Yes Nog I FHA/VA: Yes ❑ No� TYPE OF INSTALLATION AND SPECIFICATIONS: �- (No,septic tank or cesspool permitted if public sewer is"available within 200-feet.)k I I Septic Tank: �IMstance from nea estlwelf_ 1_____ __Ds#ante fro foundation___________ ___._.Material._,__._._.._______�.________-;.__---.___ ____- Disposal a��eld: Distance fromrnea est well--`� -�--_--Dze___-= Liquid depth-- --------------- ------CapacitY-4. _-------------_-____-- stance from foundation_____o`er.'.,--,_.Distance o nearest lot hne��./___ �7 { Number of lines___________________________ -- Length of each line--------- ______ _____Width o trench.-----li:_2 _--- --- Type filter materialrxDepth of filter materiaL___fl- _'____Total. length______-____. �—�.-`___ Seepage Pit: r1[7 Distance to nearest well__ --- Distance from foundation___=�Z��__ .Distance to nearest la} {ine.t_ wwrr / Number'of pits---_. - .-. Lining—ma+eriai�k� �, , Size DDept4 (� i. t r .,, i! 3 �- 'E r ° �'` t 1 I ter• ;� .�„, r I�t Cesspool: flistanc0 from nearest well---------___- Distance Barri fo nr�ation . __-'+- Lining,material _______--------------:?._ - Size: Diameter_-_ . t )De th:___ Li uid Caracit gals ❑ _ P ., 4 #` `' '� ..q P y---------- ------ g Priv A��Distan e to ©ares} lot Ie1eItf r __.'-- ;_ r � ( _ -Distance fro m nearest�buildin r• y__________________ Y❑ -5 --t - ------------------------- Remodeling and/or repairing (describe) i Y �1 �'i _-T'�;�; r = - E S __________________ _ _ ______ __ '`---.------------------------_-___t___-____.._---_. �-------------------o,_-`_____ _______`___. . _- �'''x�._ _Y___.______. ___.. f+ --------------------___----------___ ------__________F______'t-------___`__________ _-________-________.-_____________-________- . _ _'S" r.f __�----------------- --------------------------- _-__ -- -._____ \ 4 .. lg :yy � _ __ ----------------- ___�__ - _�._ __________________________________________________________________ -----------W---------------------------- r-------------—J_______- ________--.____..____ -___ *� I . I hereby cerfify +ha+ I have prepared this application and�that the work will be done in accordnce wi+h San Joaquin County ordinances. .State laws, and rules and regulations of +he,San Joaquin Local Health District t r ; (Signed) Cwt --------- - -- -------------------------------------- ----)Owner and/or-Contractor) I (Plotplan, showing size y of lot, location of s' stem in relal [Title]--------- -------- -------- ----- - ----- ------ ------ -- B ----------------------------------- p g I `r iib +o wells, can bei{{placed�on reverse side). {' FOR DEPARTMENT USE ONLYARPLICATION REyiEWED BY- ACCEPTED BY = = f ----------------------- DATE �� I�� (� '"= BUILDING PERMW�ISSUEDJ--------------------- D,°�TE-------------------------- f 1 --------- _. da A#�rla#io�and/or s�m Cn +to�_`�}�-- --=-r�--=--� .�-�-=-- -- -- �1��-.-��.'",z-��-�_-`-=--�`==-`--------•-;--------- ----- ----------------------- --- -� ------------------------------------------------------------ --------- ------ ----------------------- -------------- ------------------------------------------------- --------__.__ -_-____may.._{F.....______. Jam, _ -----------------______________________________ f4__ -_---.--_-----7--------------- -..----_-.._!�-T__.__..______...______..Y_____.______..._.}.------------------------ -------------- __.____-._._.___..___._ ---------------------- -------......---- ---------- '� i --------------- ------------------------- ------ - I L -- .------------ -'l- FINA'L"`IigS'PECTI'ON"BY - -- `�• Date `'`= - -C I IA142kOAQUIN LOCA HEALTH%DISTRICT 1601 E.Moselton Ave. '300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,Californio Lodi,California Manteca,California Tracy,California F.p.CC.