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FOR OFFICE USE w _* is ON PERMIT r Permit N.. ......�_7�---C APPLICATION FOR SANITATION ' (Complete in Duplicate) _�. ', . ' �...:� Date Issued --- -�'------ __.--___..-- This Permit�Ex ires 1 Year .From 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.compliance with County Ordinance No. 549. Y' JOB ADDRESS AND LO AT IO A- - ,� "�'- " ` Phone_..-•----- Owners Name------------=- - -• --- --"-�----- -:-��/�5-------------�--------------- --�-�-' � ---'--------'-----'-'-'---- -'--- - ----'------- � ---- Y `a,_ .�7 4 -'------------••-----------------------••--....... Address------••----------------•------------. ---• •---- -- ••- --- -�=- Contractor's Name------ sf �d `'_ :T ----•-- one---------------------------------- _ m. Ph 1 ' Installation will serve: Residence 0artment House❑' Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __J--- Number of bedrooms _Number of baths /--___ Lot size __ --x •------------------•-------- 4 Water Supply.'w Public system [7' Community system ❑ Private ❑ Depth to Water Table +��{}- f Character of soil to a depth of 3 feet: Sand Gravel Sand Loam Clay Loam Clay Adobe Hardpan f, p ❑ ❑ I Y ❑ Y ❑ Y ❑ � ❑ Previous Application Made: (If yes,date--------------------} No IL---New Construction: Yes g,-ITo E) FHA/VA: Yes No I 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---TO---------Distances from foundation./-Q----------- Material--C_C- Y/C t _ No. of..compartments----- -----------------Size__ - a-------:---Liquid depth__--Y. .,----'-'--Capacity__.d"�'__._ ------ e stance i �0 t Disposal Field: Distance fro ?nearest well____- from foundation____----Di ___ ___________Distance to nearest lot gine___ _____--_.... m -------------------- Number of-lines------_------J._�-_+f_---_`----Length of each line:.....7LI- -------------Width of trernch --�../ . {�1 i a'_Depth of filter material _'_c� -- ----___.Total len th-_--___ ____________________________ t Type of filter material___�h_-_A-- - p il ,/ g t r Q-__-I_f_<.Distance to nearest lot lin e_5-____________ Seepa e Pit: Distance to_nearest well._.______ Distance:from':foundation___ �_�. _�. ,�•� � ' umber of its__ ' __Lining materiai___�x G ____ 5ize: Diameter--- _��._.__Deptn_- _.__}_______,,�------ %,N p 1 Cesspool: Distance-from-nearest well-----------------Distance'from foundation----___._.._______.Lining material------------------------------------- - ❑ l Size:-yDameter---------------------------------------Depth----- ---=-------------- ------- --------- ----Liquid Capacity- ----------- - ----- gals. r' Privy: Distance from nearest well------------------------ ---- ------------ -----Distance from nearest building---..-..--------------------------------- -- G. Distance to nearest ;lot line--------- ----- -=------' ----------------------------------------------- Remodelin or re a7n describe -- � 1 � " ` ' �+ ---------------• ......... -------- --- �Lo fi 9_je;w- ., - - =- t -------------- ------------------------------ -w t I her certify that I have prepared this application and that the work I be done in accordance with San Joaquin. County` ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. e/Cy- Z_ N1�0+, caner d/or Contract'``l [l.J an----- Title------ _�-4�!�.�G" ---- -- -- - --------(Plot plan, showing size tion of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-----------------------lcr_fi'----'-- - T----------------------------------------------------- DATE------ -• ' 1 REVIEWED BY--------------------------------------------- ----- ------------------------------------------------------ DATE----------------------------------------- ----------------- BUILDING PERMIT ISSUED----- ------ :-- --------------------------' ---........ DATE------------------------------------------ Alterations and/or recommendations _ 5�- - �� '�`� ` — `` �` __- --------- �" \f. ---------------- ------------------------------------------- - --- ------_--------------- -------------------------------------------- -; ' ' ------------------------------------ ' ' -- ' ----------------------'--------------------- ------------------ -- , � �/� ---------------------- 'INAL INSPECTION BY:.------- ------------ -------------- ------- Date SAN JOAQU N LOCAL HEALTH DISTRICT ' t 1601 E.Haselton Ave. + ` 300 WestOakStreet .14'Syeamore Street 205 West 91h Street Off, Stockton,California Lodi,California Manteca,California Tr&�y,California