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FOR OFFICE USE: i 11. _______________________________�._�_-L �--.:� __-_. APPLICATION FOR SANITATION PERMITTir Permit NG7�J ___... � u - -r---- -- (Complete in Duplicate] --- - - - - �"" ". This Permit Expires 1 Year From Date Issued Date Issued/ Application is hereby made to the San Joaquin Local Health District for a perry if to'_consteuct and install the work herein described. This application is made inl'compliance with County Ordinance NgJ549. " y : _ JOB ADDRESS AND LOCATION. ......... ...... -:- -- -�------------------------__ Owner's Name. __X').------1 !� ------- --------------------------------------- ` �- Phone-----•------------------------------ I Address..... j r .. ------ Contractor's Name--------- Phone:-••-----_--------_-•---------- - ------------------------------•--------- ---------------------- Installation will serve: Residence [Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other E� � Number of living u fits: ____,Number of bedrooms ,,.�-_ Number of baths _Z___ Lot size 7�_�_1. s 14 Water Supply: Public system [Community system ❑ Private ❑ Depth to Water Table 04—ft. Character of soil to a dep+h of 3 feet: Sand-[] Gravel,,❑. Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 0'-'Hardpan ❑ Previous Application Made: (If yes,date--------------------) No {Y�New Construction: Yeses E] No [!r FHA/VA: Yes F] No �-• TYPE: OF INSTALLATIONAND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 240 feet.) i Septic Jank�. Distance from nearest well------------------Distance from foundation--------- Material---------------"----_-___.-___._________----_--- � �I,/'Y No. o4'compartments--------------------------Size--------------------------------Liquid depth---------------------------Capacity---------------------•-- ✓•. I" Disposal Fi�1d: Distance from nearest well----- --.-Distance from foundation___ --------- Distance to nearest lot line--------- __-__ /, l� g i Width of trench-. ------------------------- Sf Number of lines_________ Length of each line----- �_��______- ___ Type /j - p --- 'Total length------- ._----- T e of filter materraL _ __De th of filter material__� t Seepage it:- Distance to nearest well,_-__' 4__-___Distance from fou dation"_'�� ...-F_ Dis#ante to nearest lot Iine_4 __.___.. r� � Number of pits.---- g .Size: Diameterir p X--- ________Linin material_--- ._._ _-.- >,.?..._..._ C25F(ow Distanl�e from nearest well-----------------Distance from foundation--------------------Lining material-------------------------- ---------- ,r- � ❑ Size: Diameter------- - ------------ ------ ----Depth---------------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest wefl-------------------------------------------------Distance from nearest building----------------------------------------- ❑ Distance to nearest lot line------------------ Remodeling and/or repairing (describe)------------- > i .--•-----------------------� -------------•----•-------•-------•----------------------- --•--------------------- ---------------------- -------------------•-------------------------------- ------ -------------------------------------------.ill------------------------------------------------------------------------------------------------------------------ ------------------- ----•-----------------------------------. - I hereby certify that IrIhave prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, ana rules and regulations of the San Joaquin Local Health District. (Signed) I - � r Contractor) By•_ --------------------- ------------------------ ------- ----- (Plot plan, showing size of:.lot,.:location of system in relation wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY t ` APPLICATION ACC> PTE BY -------------------------------- ---------------------------------------- DATE /d--�/- �5 REVIEWED BY---------------------l' DATE ----------------------------------------------------------------- BUILDING PERMIT ISSUED-------------------------------------------------------------- •----------------- DATE-------- ---------------------------------------------Y� Alterations an /or recommendations:--------- --1.2._- ,---------- �"`"� ---- ---- ------ ----I--•-------------- --------- ^2 .-t-- ----- ------------------------....... ---------,-----� ` f :---------------------•--•------------•------•----•---------------•-------------------------------------- aM: !IMi ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ ill --------- ------ ------ --------------------------------- --- ------- ----•-------- - -"----------------- ------ - ------------------------------- I , � y --- FINAL INSPECTION BY: </L ----------•-- --- y _._ ©ate S JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hoselton Avg. 300 West Oak Street 1 124 Sycamore Street 205 West 91h Street Lodi,California Manteca,California Trac California Stockton,California, y, F.P.CC.