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OR OFFN,, ,E: ' - 1-- .--. -_1--_- t,_�,- APPLICATION FOUR -SANITATION PERMIT Permit No. 1� ---------------------------------------------------- (Complete in Duplicate) ---------- --- This Permit Expires 1 Year From Date Issued Date Issued/l-- - 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 mpde in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION___________ _ l�_- Owner's Name--------- •/ , --------- /j�/ Address--------------- - ........11 c ......-` �� ... . . �""_1 '% G------- ----------------- Phone. Contractor's Name----._______ 4-�, . Installation will serve: Residence a Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __ .,_ Number of.bedrooms __' Number of baths I-.-_ Lot size ___��_Xf_��_`�f---------------------------- Water Supply: Public system ❑ �C�nity system ❑ Private ❑ Depth to Water Table 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--------------------1 No [rte New Construction: Yes ❑ No p' FHA/VA: Yeses ._No ©— TYPE OF INSTALLATION AND SPECIFICATIONS: rel (No septic tank or cesspool permitted if public sewer'is available within 200 feet.) ` Septic Tank: Distance from nearest well-----------------Distan�'sfrom foundation-------------- ___.Material---.-___-____------._-_-.-----.--.-.-_--___-. F1No. of compartments Size - Liquid depth- Capacity pisposal Field: Distance from nearest well._..:------Distance from foundation__ /'t_.s ._.,Distance to nearest lot line____T� --- � Number of linesIf . _-_. Length of each line-- n '-Z-1,��.Width of trench.- _ .... _f=- ------.---- ❑ ___..____ _..-._ . -__-Leng - Type of filter material__ of filter mate ria l--_fF{''°-------Total length------yQ---------------------------- Seepage Pit: Distance to nearest well--------- -----------Distance fr m foundation.-.'�'��_ _..Distance to nearest lot line--2-6>___ Number of pits---------- ----------Lining material.. pit''_..Size: Diameter__ . _``__ ___Depth-------- ----__---.---.-- Cesspool: Distance from nearest well-----------------Distance from foundation------________ _ Lining material--------------------.------.--------- ❑ Siz;: Diameter - - - Depth Liquid Capacity gals. �[ Privy: Distance from nearest well------------------------- .-------.---------Distance from neArest building._-.-.----.-----.------------.---..-_----. `T k ❑ Distance to nearest lot line - --- ------f-------�------------------------------- - ---•-------- --'--------------------------- ------------------------ Remodeling and/or repairing (doscribo):- S -------------------------------------•---------•--------------•------•----------------------------------------------------------------------------------------- i --------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------.._----__ -------.-----------_.-_._ _ _ I hereby certify that I have prepared this application and that the work)rill,be done in accordance with San Joaquin County ordinances; Stafe laws, and rules and regulations of the San Joaquin Lo�al Health District. �,� (Signed)-------------.-1�-`-' .f - 5 F�' f1!,5 ..� -- -Owner-and/or Contractor) li ---------- ---------------------- �-�--------------- - --------- -- ----------- ��t� -c..5�� - Title -----� (Plot plan, showing size of l6#, locatiorf f system in relation to wells, buildings, etc., can beylaced on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY - ---------•----------------------- DATE--------tel/ �y( --C--------------- REVIEWEDBY------------------------------------------------- --------- ------- --------------------------------------- DATE----------------------•------------------------------------ BUILDING PERMIT UE ----------------- DATE Alterat4ons and/or recommendations:`------ -(=��- `-- - ---- --- - ------- ------------- • � - ---------- -------- � --------------------------------------------- �- �� ----------C----}----- r --- -------*-� �`'S'` ' r --- --------'� � / ` — 5 -p- L ----- �------------- ------------F L---•----- `t FINAL INSPECTION BY:.---- ` Date_ f r SrJOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California 1l`\ F.P.Cq. F