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FOR OFFICE USE /00?/ s I 0-- ----- --- -----41 ��I APPLICATION FO'R`SANITATION PERMIT Permit No. _��_Fr --------------------------------------------------------- (Complete in Duplicate) _ __1�_ � ------------___________------___-----__---__--------_ ___ This Permit Expires 1 Year From Date Issued Date Issued n r r--(4d- 2 --- Application is hereby made to the San Joaquin Local Healfh District for a permit to construct and install t>6 w rk here' desc -bed. This application is made in compliance with County Ordinance No. 549. �� JOB ADDRESS AND_LOCATI/ON----- -E1Q Q .fJ r z.l ,� _..- ' _ / -=, �.... ''..�, �i1 . / cls------ Owner's Name-.----/ !' � l"L � . �( -------------------------------------------- --- ----------- -- ----- -------- Phone------------------------------------ Address------------ 1' ------------------------ -------•----------------------- --------------------•----------------------------------- Contractor's Name-------- v/lam - Fl ------------------------------------------------------------------------------------ Phone----------------------------------- Installation will serve: Residence [P—Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ___4_ Number of bedrooms___ Number of baths .Z__ Lot size _�l.60-01!4_�G___ _-._ i Water Supply: Public system ❑ Community system Private ❑ Depth to Water Table ;�P 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 [ New Construction: Yes g3-'-No ❑ FHA/VA: Yes R-" No ❑ 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-----..'-_-------Distce/jjom found+ion--/49__.-:-_.--.Ma�r�l-_�.�_ -< _________- Cle Q/" No. of compartments-----�--------------SizerL3__-,?�- -_-:--.Liquid depih__"-�'--------------Capacity--y Disposal Field: Distance from nearest well_-_r_-_____Distance from foundati n--� ____._ lstance to nearest to line _.___._ Number of lines______,,,_____J.............. Length of each line_ �1r'�_SWidth oftrench-11-_-____,.______..__._.____F_ Type of filter material/�pl�Depth of filter material__ ._ Total len th____.r',u -of .�-�4 g Seepage Pit: Distance to nearest well___-"______Distance fromfo ndation__"e-_____.__Distance to nearest lot line_e� ...._ f [� Number of pits--- -_---Lining maferialeOP_edoff_..Size: Diameter....?*"�F---------Depth r,J 0 Cesspool: Distance from nearest well-----------------Distance from foundation---_-------------_Lining material-------------------------------------- 171 ._.____._.__ _________.__.❑ Size: Diameter-------------------------------------Depth-----------------------------------------------------Liquid Capacity-- -------------------------gals. Privy: Distance from nearest well___----------------------------------------------Distance' from nearest building___.________.._____________----.---_..._ 6 ❑ Distance to nearest lot line----------------------------------------------------------------------- ----------------------------•----------------------------------------- Remodeling and/or repairing (describe): - �' _1. �t �.e -------------•-------------------------------------------------------- ------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------•--------------------------------------- ------------- ------------ ---------------------•-------------------------------------------------------------------------------------------------------------------------•--------------- ---- ----- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, andrules and regulations of the San Joaquin Local Health District. (Signed)-------------------- �/e-----.--z------ - -- ------ -------------------------------------------{�9 a'41or Contractor) Sy:--------------------------------------------------------------------- - --------------- - - "------------------------(Title) f -- -------------- (Plot plan, showing size of lot, location of system ' elation to wells, buildings, etc., can be placed on reverse side). r FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---- 1�'' lC --------------- DATE------ �f ` ---- REVIEWED BY----_-------------------------- ------------------------------------------ DATE BUILDING PERMIT ISSUED-------------------------------------------- ---------------------i>------------------------------.,, DATE---- ---- - ------ ------------ Alterations an recommendations:-------------- i i Lrc--c / ^{ c `- ---`:: ,.r, -------------- --- --- ----------�7c yam--- -- �.�;r --- 771-1 - 6-�-------------- ---- --------- ---------- -------------------------- -------------- > --- � -- ti --- ----------- --- FINAL INSPECTION BY------ ------- - ---1N/f/4- ---- ------------ ------ -- Date------------------ �--- - ----- ------ ------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT r 1601 E.Mazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California o Manteca,California Tracy,California F.P.0 O.