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FOR OFFICE USE: ------------ /D --- APPLICATION FOR SANITATION PERMIT Permit No....P_L_ ozd _.--- . ----- - (Complete in Duplicate) — - - - --- - This Permit Expires 1 Year From Date Issued Date Issued ..5_.-.---_----6 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. JOB ADDRESS AND ATION....... .15.6- ---> o--.N..I3tl..... _ ` Owner's Name ....... .c.A/__.U�1� ----•--------------------- --- -._.._---------- Phone- Address----- •----------------- - -- •. 1z; -W�---------i-------- •••- - --- - ----------------------- --- -- Contractor's Name.. i Phone. / ----------------- Installation will serve: Residence U4/Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ / / Number of living units: __._ N tuber of bedrooms .2---__. Number of baths ..Cnn /_ Lot size____([1].__..._?�,--,/.-;7-t��.................. Water Supply: Public system W Community system ❑ Private ❑ Depth to Water Table _&Oft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 2"OHardpan ❑ Previous Application Made: (If yes, date .. _-- -- _ .. ) No ❑ New Construction: Yes ❑ No * FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Sf- T ) Distance from nearest well ................. Distance from foundation .................. . Material ------------------------------------ _-....._---. 4 No. of compartments_.... _..... _.... .. Size -------------------------------- Liquid depth .---------.---.._..... Capacity -•--------------------- �l Di a F' ii Distance from nearest well.q�eDistance from foundation..._ .. (` I_. _.._.__.Distance to nearest lot line______... P°i�� Number of lines I - Length of each line.. �% Q ------- - _ Width of trench.... r r Type of filter material. < < Depth of filter materia .................Total length_._..................... _0__.._ VVV11 ••- Se Pit: Distance to nearest well-M0.14V- .Distance from foundation..__rt__ _____ Distance to nearest lot line .______-- Number of its._. _ Linin p• �---- --- ..- - g material_.�.Size: Dia mete r__._3�-��-- Depth ...... ��'---__.._._.... Cesspool: Distance from nearest well ----- ..___..... Distance from foundation .................... Lining material -------- _..._....................... ❑ Size: Diameter- -- --- ----- ---------------- ----Depth----• ----.._ - --------._...--- ---------• .... Liquid Capacity__-. -------gals. Privy: Distance from nearest well...__ --------- -_...................... .....Distance from nearest building ------ ..--- --_- ---------------------- ._. 3% ❑ Distance to nearest lot line....- .................... --- --- ----- --------•--------------------------••---•----- - _.. Remodeling and/or repairing (describe):._.._.._ . .. • -- V/1 ----------------------------------------------------------------------- -- -- ------ -- 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, and rules andel regulations of the San -Joaquin Local Health District. (Signed)- #1-�QC/ '../..f C'-'/��/---------- eF311160 • Contract or) BY- - ------(Title)---------- ------------------ -- ----- (Plot plan, showing size of lot, location of system in relation wells, buildings, a ., can be placed on reverse side). R DEPARTMENT USE ONLY APPLICATION ACCEPTED BY. --� - ......... -------------------------------------------- DATE ....... c4.7//7.�15 REVIEWED BY----•---------------_... ........ . ------------- ......... --------------------------------- - ------ DATE---- BUILDINGPERMIT ISSUED ------------ --------- ---------------------------------------------- ----------------- DATE--------- ------- ---------- ----- ------------------------- Alterations and/or recoppendations:......... _--- --- ------ -------- --- - �1/ I -- ------------------- .... ........... ----- AP - --------------------------- ---- ------ ---------- ---------- -- --- -------------------- -- -- --- ----.. ............ .................... ------ - --- ----- -- -- - ------ ----- ------------------------------------------------------------/------------------------------------------- - FINAL INSPECTION BY:...... E� ....... ...... - Date----- 6 -�6 .......... - - - _.... N JOAQUIN LOCAL HEALTH DISTRICT 1601 E. Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton, California Lodi, California F.P.CC. Manteca, California Tracy, California