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FOR OFFICE USE:: ______ __________ ____ _________________________________ APPLICATION FOR SANITATION PERMIT Permit (Complete in Duplicate) 4 i Date Issued:::=fJr�- G ------------------------- This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Heal+h District for a permit to construct and insfall the work herein described. This.application is madILA41TION c m liance with County Ordinance No. S49. Z'Zs�— 25t7-;(,s ��Ljw,p ' ' f ) �JOB ADDRESS AND C R----------!!W -------� Q---� ---- TI- =------------------••-------- Owner's Name------------- s..,/ �1��-l�.c -s�---------- ----- Phone------------------------------------ Address-----------1 IT ------ k-------2 s� = T Contractor's Name-Al� �_ }�-�? 5F_271-c, ;-GER ----------------------------------------------- Phone----------------------------------- Installation will serve: Residence R4,-Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _1_____ Number of bedrooms--- Number of baths __t/_ Lot size .- .________________________ Water Supply: Public system ❑ Community system ❑ Private Rr--Depth to Water Table25 ft. Character of soil to a depth of 3 feet: ' Sand E❑ Gravel ❑ Sandy Loam ❑ Clay Loamlay ❑ Adobe ❑ Hardpan 0--- Previous Application Made: (If yes,date-------------------_-) No Kr--New Construction: 'Yes Ij�o ❑ FHA/VA: Yes ❑ No [fir TYPE'OF'INSTALLATfON AND-`SPECIFICATIONS: (No septic tank,or cesspool permitted if public sewer is availa6 ."within 200 feet.) y s _ ROO-------.Mater al--�Qt�C��T�. �------- ; Septic Tek: Distance-from nearest well____�_P-�_________Dis#arlce from foundation__ � [s]� No. of compartments------ ----------Size- S------,P//g------------Liquid depth------ ------------Capacity-/a QDisposal1 Field: Distance from nearest well..•]�.--._Distance from foundation to nearest lot li�e___�______... �l � Number of lines__.__--_�-----------------------Len Length of each line--.��-_---��_----.Width of trench__-:1 I 9 ----- I Type of filter material-RV_C-�___ Depth of filter material------�9.----_---Total length---------------F- ---------_ 4 I �� )` 1 Seepage Pit- Distance to nearest well--- + -------Distance from foundation____:_______-------Distance to nearest lot line----------------- Number of pits__._ -.-_----_-_Lining materiaLRP.�X.....Size: Diameter--'-/- _-----Dept h____-_1Z___'._-________ Cesspool: Distance from nearest well-----------------Distance from foundation-------------------.Lining material----------------------------_- ❑ Size: Diameter--------------------------------------Depth--------------------------------------------------._Liquid Capacity----------------------------gals£ Privy: Distance from nearest well-------------------------------------------------Distance from nearest building---.____------__-_.-________-__---_____. ❑ Distance to nearest lot line----------------------------- --------------------------------------------------------------------------------------------------------------- Remodeling and/or repairing (describe):------------------------------------------------------------------------------------------------ ------------------------=------------------------------ F ---------------------------------------------------------7V-----R&t AA-c- w...----E;o -:P_S7__r_n"------------------------------------------------------------------ ---------------------------------------------------------------------------------------------------•------------------------------------------------•---------------------------------------------------------------- -� ! hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. Si ned Owngr and or Contractor By:------------------------------------------------------------------ ----------------------------------------------------------------(Title)------------------- -------- - -------------------------------- - (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------- ---------------------------------------------------------------------- DATE------ --- REVIEWEDBY------------------------------------------------------------------ ----------------------------------------------------------- DATE------------------------------------------------------------ BUILDING PERMIT ISSUED-_-------- `------------ - - ---------- - DATE------------------------------------------------------------- Alterations and/or recommendationsc. p�z0 ------ ---------•------------------------•---•-------•---------------- ----------------------------•---------------------------------------------------------------------------------------•---------------------- 'o k --------------------- -- ------------- -- ...... .:.- ------- - - ------------------------------------- ------- --- ---------- ----------------------:---- FINAL INSPECT --- -- -• Date------------ ----------(0 7,6 - '----------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1401 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California r.P.CO. -