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Fl1,C UJC: .. T_,..^-- -•..- ----�-Rr,,,.T. ----_-------------__ ------------------------------- ------------"--------------------------- __ -------- APPLICATION FOR SANITATION PERMIT Permit No. ... _.. .7_- 1 --------------------------------------------------------- (Complete in Duplicate) This Permit Ex fres 1 Year from Date Issued / Date issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and in al�e work herein descrb d. This application is made in compliance with County Ordinance No, 549. `JOB ADDRESS AN LOCATION_____""�_--t,-. .� Owner's Name-------- ---1 _ --------------------- ------ -------- - Phone-,--- --------- ----•�t Address-----•----------•----------- �:•�•--I----- [.----�� t�__ _ -�---�----•- _ -------------------------•----`-------------------- --- Contractor's Name____ _" -•D_ -------------------------------------------------------•------------------------ Phone _.-----------------•-------------- Installation will serve: Residence '[ partment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -__ .._ Number of bedrooms �-- Number o fhs _��_--'Lot;'size __-_- Water Supply: Publics stem ' --- ---------------- PP Y' y ❑ Community system ❑ Private Depth to Water Table S�{t, Character of soil to a depth of 3 feet: Sand 0 Gravel ❑ Sand Loam ❑ Clay Loam ❑�001 Cl ❑ Adobe Hardpan ❑ Previous Application Made: (If yes,date.-_::---_- } No New Construction: Yes �, TYPE OF INSTALLATION AND SPECIFICATIONS: FHA/VA: Yes ®o ❑ ' '(No septic tank=or-cesspool permitted if public~sewer is available within 200 feet.) Septic T Distance from nearest well ------Distance from foundation__ _-g_ h p -__Material_-___ -- Q(C" � - No. of compartments -- -- _"-----Size_--,Z11)f r-[�it?_Liquid depth-------W----- p Y p�. Number of lines______ ` t dation_-_.lQ�•-_---Distance to nearest lot line __--- Dis oral Field: Distance from nearest well----_S74),_/. -Distance from faun T e Length of each line'-----��_ _ .__ �-Widfh of french---� ! l yp of fitter material-__- _ / -.-L_- j --- epth of filter material._-__ �l t ----Total length_" Q? �j 1� Seep it: Distance to nearest well-_-_____-_--._ � j"r""—'""— -"'"- Distance from foundation__"_ _ .__ Disfance to nearest lot line rR1 Number of pitsl------- ,-----Lining material---------- -- Size: Diameter_ ,_. Depth{--- � +. 1 esspool: Distance from nearest well----------------- from foundation _"_____�_-_-iLining material_--__-._-_._-_-_-_---_ ❑ Size:,Diameter.__- .._ "_ I . r 1 -- - -- --- --Depth------ - -- ------ " T Liquid Capacity ----- --- i - - rrvY: Distance from nearest well _____________ - p Y-._._ ---gals. r --- Distance from nearest building.- -E]•❑ Distance fo-nearestlot line-------------------------- --- ------- -- '~r~~.r-,�,.-.,._i_ 9-- ----------------------------------- I -- ---------------------- ---� -------- ------------- ------•------------------------- Remodeling and/or repairing (descrii�e) tT /� - - -- f <---- ' + r• -- -------- iA4",%p -'---4---r'F"'f-'---g----------•--•---•----f-- ------------------------------------------ --------�---- _________ ___________________________________________________ .___ #-__-. ________"-__"_."______--_-._.-.._-__"".__.___"_-_-__-. C I hereby certify that I have prepare-this plication and that ih-G work will Abe done-in accordance with San Joaquin County l ordinances, State laws, les and regu to o the San Joaquin_,e cal Health District. ? (Si9ned}" .` `A A � = ® yw (Owner an t -1 dor Contractor) (Plot plan, showing size of lot, t of system in relation to wells, buildings, etc., can be placed on reverse s, _, 7 } FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY.-_.( _.� � REVIEWED BY-- DATE"-.. - -r- -' - -- -------------- ------------------------------- BUILDING PERMIT ISSUED--- ------ ---------------------------------------------------------- DATE--------- -- - ---- ------- --------------- ------ DATE.------------------ Alterations and/or recommendations -----------"- f -------------------- ---------- +: ----------- f 1 ------------- ____-____-._- --------------------• FINAL INSPECTION BY:/I-. _W_ea • - Date a SAN JOAQUIN LOCAL HEALTH DISTRICT s 1601 E ka:alton Ave. 300 West Oak Street 114 Sycamore Sheet Stockton,California Codi,Californid ry� e —1 105 West 9th Sheet Manteca;California Tracy,California