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FOR OFFICE USE: 2 - 77-,- ` 3-__ --_G- ------- __________9 t APPLICATION FOR SANITATION I•-.<MIT Permit No. -----o l --------------------- (Complete in Duplicate) Date Issued ^�� ---3 r . ............ L This Permit Expires 1 Year From Date Issued 131 _Z?a_� Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the worK described. l This application is made in compliance with County Ordinance No. 549. 11 ` `�r J JOB ADDRESS AND L ATION_�__ ___ -----'�r___e�1_/)_/aa, +�f�---.�/?__ - --L�---P -----1 11' Owner's Name--------- - --��-,�------- ie/1 .........--------------------------------- -------------------- --------------------------- Phone------------------------------------ Address---------- � .�,�- --------------------------------------------------------------------------------------------------------------------------------------------------------------------- Contractor's Name----- •---------- ��•� ":� Phone ( ` ---------------- ••--------- - -- ------------------------------------ - Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Mote ❑ er` Number of living units: __r__-- Number of bedrooms -------- Number of baths __/_- Lot size ------------- Water Supply: Public system E] Community system E] Private 01-5epth to Water Table lAft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date,,_________________] No ® New Construction: Yes gr'07-No ❑ FHA/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 from nearest we __..��._.Distance from founds i Z __ _.__ Mate ial. - -_ - ----------- (�� No. of compartments-- ,jel -- '� 1 _--- iduid depth--- ------ -- ----Capacity : --- Disposal Field: Distance from nearest well__�f-�i _'_Distance from founds ioa_.e— -----Distance to nearer I t line_--__ [� Number of lines_____ ______ Length of each line &XOP-----.----Width of trencF�d��___�� Type of filter materiaC _.Depth of filter material_ orep .__________Total length ° -------------=, Seepage Pit: Distance to nearest well_._.-__-_.°_.___--___Distance from foundation---_---------------_Distance to nearest lot line_______.__.-____:. r + V, f [j Number of pits----------------------Lining ma#erial-----------------------Size: Diameter------------------ -- Depth-----------.---------------------++ Cesspool: Distance frominearest well_---__-_.-- -__.Distance from foundation....................Lining material_._._-------_.._----.----___----___-I ❑ Size: Diameter------------------- --------------.Depth-----=---------------- " ------- -----------Liquid Capacity--- ------------------------gals a ; G Privy: Distance from nearest well................ Distance from nearest building--------------------__.______.._----____.a _ F; �] Distance to nearest lot line------ -- - ------------- ------------ =------------------------ i Remodeling and/or repairing (describe):_ '------------------------------------------ ------- -- ------ --- -------- .__ -____------. J �` 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 and regulations of the San Joaq n Local Health District. g . (Signed)------------------------- -. �4_ y -i-T------------------------ and/or Contractor) By:-------------------------------------------- �--------------------- - c' (Title) ..... { (Plot plan, showing size of.lot, location of system in relatio wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY r� } s APPLICATION ACCEPTED BY.- -'e --� -- - ----- -- - --------- ---------------- ----------------------- DATE-, - ------- Z - ZJ REVIEWEDBY------------------------------------------ --------------------------------------------------- DATE-------- -------------------------•-•---------•---------- BUILDINGPERMIT ISSUED---------------- ----------------------------------------------------------------------------------- DATE------------------------------------------------------------- tAlterations and/or recommendations: --------------- - ------------------------------------- --- ------------------- -------•----------------------------- --------------------------------------------------------- - • ------.------------- --- ----------------- - ------------------------- --------------- ---------- ---- -- -------- -------- ---- ------- Date.- - ---------------------!----------------------- FINAL INSPECTION BY-- ------ =-----=- --• -- - - - - --------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E,Haxelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California 4