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F R OFFICE USE: ---------- �►PPLICATION FOR SANITATION PERMIT Permit No. .7 ----- --- ----- 1---------- -- (Complete in Duplicate) -- This Permit Expires 1 Year From Date Issued Date Issued ------ ---7-r-_&S 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-------------------'2D3-1------ S--`--------- vf , /e'-- •------ -- --------- ----------------------------------------------- ----- -Q�7�� / ---- ------ ----- -------- Phone----•--------------------•-•-------- Owner's Name ---- ----------- '�------------ -�--�-ltl.- p_/---------------- — Address-----------••-•-•-•-- ---....•-------eA62-1---------Jf�----------V//---le+ --------------------_---------------------------------------------------------------- ---------------------------- Contractor's Name 7— ---------- - -------------------- Phone-_- 66 �'o Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __f___ Number of bedrooms _1---_ Number of baths _/... Lot size _----ea_X_____.?r-0t?------------------------- �,/ t Water Supply: Public system [f7 Community system ❑ Private ❑ Depth to Water Table 0!'0- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date--------------- ---) No E5- New Construction: Yes ❑ No [3—FHA/VA: Yes ❑ No [-� 1 TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well-----------------Distance from foundation--------------------Material---------------------------------------------- ❑ No. of compartments-- - ---------------------Size=-------------------------------Liquid depth--------------------------Capacity----------------------- Disposal Field: Distance from nearest well-____=-------Distance from foundation---/Q_*------Distance to nearest lot [� Number of lines------ ---------- _______Length of each line_____Xto-`-------------Width of trench . --- - - - ------------- Type of filter material-_--_ '.r Depth of filter material-_40,_'!.-_-.-----Total length--------��---------------------_- Seepage it: Distance to nearest well------—------------Distance dfr9A foundation_-oA0---- Distance to nearest lot line--.--r5-----.- � E!KNumber of pits--------�.--.---.---Lining material--/ -Size: Diameter-- -- Depth_ 15' Cesspool: Distance from nearest well-----------------Dista-rice from foundation--------------------Lining material--_--_-_.__------------------------. ❑ Size: Diameter----1� -------------------- ----------Depth--------- ---------------------------------------- Liquid Capacity---- ----------------------gals. Privy: Distance from nearest well -------------------------------------Distance from nearest building--- -- ---------------------------------- Distance - - ----- Distance to nearest lot line --------------------------------- ----------------------------------------------- ------- ('�- . i 0 Remodeling and/or repairing (describe)_______________._____._. . � - -- 1 ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ G --------------- ---------------------------------------------- --------------•------------------•---------•----•--------------------------------------•-----------------------------------•--------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State law and regulations of the San Joaquin Local Health District. �d .sT� 4L.�C (Signed)----------------- /� l - = ----=------- wn and/or Contractor] BY: -��--- -----------------------------------------------__(Title) '- ------- - - ------ ----- - (Plot plan, showing size of lot, location of ystem in relation to wells, buildings, etc., can be placed on reverse side). .i 1 FOR DEPARTMENT USE ONLY j APPLICATION ACCEPTED BY-------- r ----------------------- ---------------------------------------- DATE----- `1__7 e'277�--------------------- _REVIEWED BY------------------------------------------------- ---------------_ ----- ------ DATE----------------------------------------------------------- BUILDINGPERMIT ISSUED-----------------------•------------------------------ ---------------------,-------------------------- DATE----------------------------------------------------------- ` iterations d or recommendations:--- ------ ----------------------------------------------------------------------------------•----••-•--------------------------------------- ---------------- -- °Tr- > :------------------- � '---- ---------------------------------------------------------------------------------------------------------------- ------------- ------------------------ -------------- - --------------------------------------------------------------- ------------------------------------------ ------------------------------------------------------------- FINAL INSPECTION BY:.------ i` y.` ---------------------------- Date.-----`� /'� � ------------------- --------------------------- •SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.kaseilon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi, California Manteca,California Tracy, California F.P.CC: