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FOR OFFICE USE: - : a _ APPLICATION FOR SANITATION PERMIT Permit No. f ---_ t.`�--..j (Complete in Duplicate) - ------- ---- ----= -------- - ---- --------- Date Issued _-------------------- -- This Permit Expires 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. 55449. JOB ADDRESS D LOCATION---------/&//------------ ------(�lJ�E' -../----- ----------------------------------------------------- Owner's Name----_161.14- ---=--- -C'�-�1- �-Lti�--- --------••-•--------•-------------------- --------------------------------------- - - - - Phone--_ •--------•----•-•---- I Address ' ev a_. _ -------------- ------------ --- ----- ------Contractor's Name--------'' -----_--•-- - a0-- - -------- --- - --------- - - ----- Phone------------------------••-------'— Installation will serve: Residence [F/partment House ❑ Commercial ❑ Trailer Court K4otel ❑ Other I]' Number of living units: _ __._ Number of bedrooms ___1_ Numb�ers _-_-_f_ Lot sze . --.- -- '` v' Water Supply: Public system ❑ Community system ❑ Private to Water Tablft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Kj--Vrardpan I 00 Previous Application Made: (If yes,date----- ------------) No 12--�New Construction: Yes [I No, HA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: ` (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance frorn nearest well-________________Distance from foundation-------------------Material_..._-_--_________..____.___-._--__...____.__.__. Liquid de th--------------___ ______Capacity o. of compartments_ ------------------ Size-----------------------------_.. q I? --------- Disposal ---------------I-Dis osal •eld: Distance from nearest "ell .-- Distance from foundation. - --/`---"-Distance to nearest lot line__----------- - -__.____ p� Number of lines---------------- ---Length of each line---W-------- -�- -Width of trench------------- .�/_--------.- 1 �S•%/N' Type of filter materialJ_Y2.-�C/ Depth of filter material_ fr---:__________Total length__' - -_ 5�_ ________�_.-- - w Seepage Distance to nearest well/ _d--_.____Distance fm foundation_ a-- --------Distae to nearest lot line- --- s Number of pits------I-------------Lining material-__14-Age-._ ---Size: Diameter__ -�r?- .......Depth---------------- Cesspool ----- 5Cesspool: Distance from. nearest well-----------------Distance from foundation___;_._._._._______.Lining material----__...__________.__-----______.___. ❑ Size: Diameter------------------- ----------------- Depth------- ------------------ ---------------------Liquid Capacity--------------- ------------gals. Privy: Distance from nearest well-------.------------------------------------------Distance from nearest building---------------_---- ❑ Distance to nearest lot line------ -- ---------- -----------1 -- -------------------------------------------------------------------------------------- -- Remod ling a repairing {describe)---------------------- � -- CIO /.1%... ------------- - - `'�+ -------------------------------- -------------------- 4 _ ________________________ ______________________________________________________________________________________________________________________________________________________________________________________________________________ r s.w�-a....h =b I hereby certify that I have IL pre are -this application and that the work will be done,in accordance with San Joaquin County ordinances, State la d rules regul tions of the San Joaquin Local Health District: ___----_Owner and/or Contractor (Signed)-----=---------- -- - -- - -- - ---------�_._ -- • -- ------. [ / I Y• ----- ----=-----------------------(Title)---- -J / ----- (Plot plan, showing size o , location of system in relation to wells, buildings, etc., can be place on reverse side). F FOR DEPARTMENT USE ONLY t APPLICATION ACCEPTED BY_-_____._ DATE-------- __ 1--. ---.-----_--------------- - ---- --E�"------- -------------------`---------------- REVIEWED BY------------------=---------- - ---=--"--------- --_ _----__:-:----------------------------------,DATE---------------------------------- - -- - - BUILDING PERMIT ISSUED_ ----------- _ ATE - .: Alterations and/or recommendations:-- ------ - / ----------- --------- --------------------------------------------------• �j'�'---- --- - :----------- / --------------------- -- ------------------=------------------- -------------------------------------------------------------------------------- ----- --"--------------------------------- ------------------------------- �/i� Y /�� FINAL INSPECTION BY:-.- Date.. -- 1. ----------------- ------------ SAN JOAQUIN LOCAL HEALTH DISTRICT y. 1401 E.Haxelton Ave. j 300 West Oak Street r ; 124 Sycamore Street 205 West 9th Street x ' stockton,California Lodi,California , Manteca,California Tracy,California F.P.c a.