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tUN Utrll•t ubt: _.'./r.//-d'L .,�Y_._ PI-7_.__-_.-. APPLICATION FOR SANITATION PERMIT Permit No. ....1.�L`_G. _..__-------------------. ---------._------------- (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 permit to construct and install the work herein described. This application is made in compliancewithCounty Ordinance No. 549. JOB ADDRESS AND LOCATION_.rL 0-r. .._._ T `iY J / // J / ---- - --------- ----- li Owner's Name ._Ga.. _ �._{.. _ !.t.:.`. ...� .-.:_.-._. . - r- . . _-. ... . .. -. _. Phone ......... ........._ _. Address.......`: .- /' Contractor's Name,_____. /... ........... .............----..---------------................... • ......-..-----------------. Phone......................— -- Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Ceert [] Motel ❑ Other Number of living units: Number of bedrooms__/- Number of baths -f._- Lot size __°.....c---.------: ...:.l._. .-:i_-_...__----- Wafer Supply: Public system ❑ Community system ❑ Private n'bepth to Water Table 6.2-_ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam❑ Clay Loam Ey - ❑ Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date... ................) No [f],- New Construction: Yes V]--No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) i /i Septic Tank: Distance from nearest well--. ' `, .-_Distance from _foundation G -__..Material !J- �.` . f El No. of compartments ----.. -: ....Size f- �..I. Liquid depth.__ _... Capacity [ ,-z,{/-'} Disposal Field: Distance from nearest well i_`......Distance from foundation.._...L�r P ,-� - , j....,.-----Distance to nearest lot line 7.............. �-'- Number of lines_-_.._-�._)--._-_-----__-_Length of each line..- °....... -Width of trench.. .'�.................... Type of filter material._.y -k- _;`:_::Depth of filter material__.../-X _-.Total length----------_?_�........ Seepage Pit: Distance tonearest well----------------------Distance from foundation--------___.......Distance to nearest lot line................. ❑ Number of pits---------- -----------Lining material-----------------------Size: Diameter.......................Depth_..............-.-._.--------- Cesspool: Distance from nearest well.................Distance from foundation--------------------Lining material..............-----..._._---.--_-.- O F1Size: Diameter-------------------------—...:----Depth----------------------------------------------------Liquid Capacity............................gals. It Privy: Distance from nearest well ...............................Distance from nearest building-------.................................. D ❑ Distance to nearest lot line---------- .- .. ....._- Remodeling ano/or repairing (descnbe ✓ ./< < t ( c E l`' ! .max - /! - l , I here efti +hat I have pre r his applica+ion and that +ha work__will be done in accordance with San Joaquin County ordinances, a nd a g tions of the San Joaquin Local Health District. (Signed)------- -. . .- - '-------' ---.. --------------------------.---- -----------__..............(Owner and/or Contractor) By:--------------------------............ _----...._.-----' ------- _....._._--------------- _._(Title).------------------ — (Plot plan, showing size of lot, locat of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY._- /(1; ... --------------------------` -------------------- _ .. DATE...1�. --- .: `------ REVIEWED BY---------------------------------- _ .. .... .........._ _.__ .--- - - _ -- - - . ...- --- -----------_.... DATE-------- - ............................................ BUILDING PERMIT ISSUED--------------------------- - - ---------.----..----- - ------------ DATE.------------------ Al+era+ions and/or recommendations:----- ----------- --�-�-"-=-�: --- ---._s:<:e.!:= " { -r ................_..._._._ ......................................................_.._._.-._.._._._..___-------------- ........................................................__...................... _. .... ........ ----------'--'. _................ .... .. - - -____ ._..._ ________........................................ .... .... ............... FINAL INSPECTION BY:. ..... .......... ........... ..... ..--------- .......... Date.-..11/f f i SA JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Ho.ithon Ave. 300 West Oak street 124 5v,amore Street 205 West 91h Street Stockton,California Lodi, California Manteca,California Tracy,California ES 9 REVISED a-99 3,n 3-'63 F.P.00.