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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. -------------- ----- - -------------------------------- (Complete in Duplicate) bate Issued ----------------------- ------------ ------ _1�I;.,---,------ This Permit Expires I Year From Date Issued Applica _,-,�sreby made to the San Joaquin Local Health District for a permit to construct and in�st�all the work herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION �! �`= /!'�' !D r ��c -' --�% Owner's Name /t� 1 -.---- Phone r Address .S r• L-Z-�/ -''f9��"'� ------ 1 �" = Contractor's Name --------------- ------------•------------------------ ------ Phone__�V�__ p_7_.. _. Installation will serve: Residence �artment House El Commercial 0 Trailer Court El Motel ❑ Other ❑ Number of living units: _ ___ Number of bedrooms J(__ Number of baths -------- Lot size ar..21n5 ' e-____________________ �t Water Supply: Public system ❑ Community system ❑ Private [Depth to Water Table j6?�d ft. Character of soil to a depth of 3 feet: ,Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam Clay-E] Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date--- ._._:_._____) No EB-*� New Construction: Yes ❑ No B FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: I (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic ink: Distance from nearest weIN�N_ .__Distance from foundation_�,Q.________-_-Material_______ _____ 0/ No. of compartments..._. _______________Size_ - ---------Liquid depth__.r!_` _`�-._______Capacity_/4Ze94_C / 1 Dispos Field: Distance from nearest weii_-17........ .Dlstance from foundation /f1___ ______Distance to nearest lot line__-J�_____.__. Number of lines____ ____ ___ Length of each line-_--t` d~e�_-'�rWidth of firench._ -.��------------------- -- ^/_____________-_._ -- ---- Type of filter material____/t�A.4i-__Depth of filter material__a______________Total length__._l�d..-.--____-__-_______ 5eepag it: Distance to nearest well_ g9------------Distance f/m foundation__AB._�..___.Distance to nearest lot I'sne._�v_�___._ i Number of its-') -----------Linin material-- Diameter_ `__'__._ ' a S_'_______________ �` 4 p' g ;J 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-------------- A' ❑ Distance to nearest lot line-------- -------- ----------------------------------------------------------=------------- � Remodeling andor repairing (describe): 1 "40 �-— —i ------------------•--------------------------------------------------------� x ------------------------------•----------------------------------------------------- ------------ •-------------------------------------------------------------------------------•--------------- --------------- M €I EI 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 s and regulations of the San Joaquin Local Health District. E10.1 (Signed) - ----/�'A011119-11S.- 1f r .- � _ - wn and/or Contractor) (Title) -- ------------------- a; ----------------- 1 ------------------------------------------------------------------------ ---- ----- ------- - -- (Plot plan, showing size of lot, location of stem in relation to wells, buildings, etc., can .be placed on reverse side). r ' I FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------------- - ------ ---- ----------- DATE------- ------------------ REVIEWEDBY--------------------------------------- -------- -------------------------------------------------------------------------- DATE-- ----- --------------------------------------------------- BUILDING -------------------------------------------------- BUILDINGPERMIT ISSUED------------- ---------------------------------------------------------------------------------------- DATE.- ---------------------------------------------------------- Alterationsand/or recommendations:------------------------•---•---------------------------------------------------------------------------------------------------------------------------------- ---------------------- 1 ---------------------- - ------------------------------ I-------------- --------------------------------------------------------- -------------------------------------•------------------------- -------------------- t- ' FINAL INSPECTION BY:---- -s - - ---------------------- Date--------5�------ ............. ---------------------------- , SAN JOAQUIN LOCAL HEALTH-DISTRICT 1601 E.Haxeltan Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California