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FOR OFFICE USE: ,r permit No. ----------------------------------- } APPLICATION FOR SANITATION PERMIT '------- -------------------- ------------------------ (Complete in Duplicate) Date Issued 1' This Permit Expires 1 Year From Date Issued - ------------------------------- ----------- Application is hereby.made to the San Joaquin Local Healfl District for a permit to construct and install the work h rei scr l This application is made in compliance with County Ordinance No. 549, L f JOB ADDRESS AN CATIO !�� * <° --- ------ --` - - ----/ _ Owner's Name . .... Phon - Address----- - - -� --- ---- ------------------------------------- ---------------------------- ------------•-•------------------------------=------------•----------------------------- Contractor's Name-_. Phone Installation will serve: Residence W--A' partment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: V--- Number of bedrooms %Y_ Number of baths _f__ Lot size 1_j0jC; r-dV------------------------------------ Water {____________ ________________Water Supply: Public system ❑ Community system ❑ Private V*Depth to Water Table 4knf 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 gr" New Construction: Yes Ug"'o'No ❑ FHA/VA: Yes We' 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 w Ii-!0W_..__Distance from foundation_ .��.....____.Material-- _�f'------ --------------- - No. of compartments_ _'?-------------------- Siz �_��e!G?�iquid depth-___ 'r -Capacity/2.&&�,W.--. 10 �._Distance from foundation-Al..-..___.Distance-to~nearest lot lines .___-_----. Disposal Field: Distance from nearest well-Of ---_--f-- _: •Number of lines----- Length of each €ine__A��___---------- � th of trench_,r�..____...................... T e.of.filter material_/,p. __De Depth of filter material. __Total len th-_ _eV49----------------------_r Y p f+ g F p itn.:,, Distance to nearest wefL._ f___._ Distance fr m fo dation__ sf�=:__Distance to nearest lot line _ See�age,P � a� _-- Number of pits---->��__------- . Lining materlal_.�� _. _...__.Size: Diameter � �--.-----Dept h" 9 - s ool: Cess p Distance from nearest well-----------------Distance from foundation____----------------Lining material_--. .....__ ___--.___._______ ._. ❑ Size: Diameter------ ---------------- -----------Depth--------------------------------- ------- ----------Liquid Cap6city- - ------------------------gals. Privy: Distance from nearest weli----------------------------------------------- -Distance from nearest building----------------------------- --- -- ❑ Distance to nearest lot line---- --------- -------------------------------------- --------------------------------------- E Remodeling and/or repairing (describe) 4_ ,Iaw�'/ 5. ,, > . . } ------------------ ------------------------ ------------------------------------ -- -- -------- -------------------- - ----------------•----------------------- ----- ---------------------------•---------- --------•--•------- # - -- r I' --------------------------------------------- - - -------------------------•----------- -------------------- -------------------------------------------------------------------------------- ---- --- 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 Joaquin Lccal. Health District. [Signed} c~ '`� ` --------------- or Contractor) -! trifle) . Piot Ian, showing---------- By:_ 3 '� ( p g of lot, location of system in relati o wells, buildings, etc., can be placed on reverse side). t � a FOR DEPARTMENT USE ONLY i ,r APPLICATION ACCEPTED BY----.. _- - DATE------e_777/ ' _ ------ REVIEWEDBY------ ------- ----..--- ---------------------------- ------- ------------------------ .. DATE---------------------------------------------------------- iBUILDING PERMIT ISSUED------ ---------------------------------------- ------------------------------------------- DATE------ +---------------------------------------- Alterationsand/or recommendations:------------------------------------------------------------------------------------------------------------ ------------------------------------------- t r .. ------"'.=-- - --------------------------------------------------------------------------------------------- -------- ------------------------- - - ---------------------- --------------------------- -------------------------------------- -- ----------------- ----------------------------------- ------ ---------------------------- ----------------- ---------- --- I . Date----- - _ -�- ---------------- F€NAL INSPECTION BY:_. .;. SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E,Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.CO., - 4.