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FOR OFFICE USE: ----------------------- APPLICATION FOR SANITATION PERMIT Permit No. .�. - .� ------ -------------------------------------------------- (Complete in Duplicate) Date Issued . 3 - --------__--------____________________________----------- This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. `Tt}iss as lication is made in compliance with County Ordin e No. 549. /V— W ��/✓�,� O�B ADDRESAND`LOCATIO � � N � --------------ox 6 -----`42r------------------------------------------------------- S Owner's Name------------ ��/J/- //��4f'/ i�l phone--7 1' Z - Address---------------------------A-..T-----0-----•----- j x. `-� ---------- ---------------- Contractor's Name-------- �`J�^ {,� 7t •.1 ,----------------------------------------------------------------- Phone-f2;5,6__,��---��Q ' Installation will serve: Residence D4partment House ❑ Commercial ❑ Trailer Court ❑ Gioe -001va-le Other El Number of living units: --- ___ Number of bedrooms ._.Number of baths __/____ Lot size ___ ._ _______________ Water Supply: Public system ❑ Community system ❑ Private �epth to Water Table __Ift. Character of soil to a depth of 3 fee+: Sand ❑ Gravel [❑ Sandy Loam ❑ Clay Loam ®.Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (if yes,date--------------__...) No �ew Construction: Yes ❑ No [3-"1FHA/VA: Yes ❑ No 0— TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest welt__ ,-____Distance from foundation____.__---.____. Materi !___.R6140-_��___---- ❑� No• of compartments----------.�.._________-Size---4 �`_ '�j..._Liquid depth_ .��_-------__Capacify__,?°�.___-�� Disposal ield: Distance from nearest well__-,�49.._Distance from foundation___._`j__-_.._...Distance to nearest lot line-_�-,r�.1_e. f 2.11 Number of lines------------ _____________Length of each line___-_Qd_____________-Width of trench____.r1. __.________________ Type of filter matariaL__ �p_E --Depth of filter material---/4P ------- length2_---_____________________ Seepage t: Distance to nearest welL..�Q _P____Distancefr foundation--------------------Distance to nearest lot line___�y�� ------ Number of pits:_..___�____.______Lining mate rial__� �4�_..Size: Diameter_.-_4F5.-"_...___Depth..._..A_Z-5-`__ A Cesspool: Distance from nearest well---------_-------Distance from foundation__- Lining material---- ---.__._.---------.._-_____..._ 1 ❑ Size: Diameter--------------------------------------Depth----------------------------------- ----------------Liquid Capacity------ -----------------_.gals. 0 Privy: Distance from nearest well-- ----------- ___Distance from nearest building G ----------------- - ------ -- g----------------------------------------� 4" ❑ Distance to nearest ]of line---------------------- ----------------------- ----------------------------------�---------------------------------------------------------- Remodeling and/or repairing (describe)----------- -----------J�_r'. --------7- �•- ---- ------ V ------------------------------------------------------- -------------------------------------------------------------------------------------------------- -- �. ---------- 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, es and regulations of the San Joaquin Local Health District. (Signed) ----- 'Q = •S �------�'`'t ------- ------ n nd/or Contractor) By------------------------------- ------- ------ 4• (Title)--- --- (Plot plan, showing size of lot, location of s stem in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_ _ ---------- DATE--- --_ .__ _ __`r-__ ._ REVIEWED BY---------------------------------------------------------------�/ -- - -- --- - ----- ------------ --------- DATE-------------------- - ------------------ - --------------- BUILDING PERMIT ISSUED-------•-------------------- -- ------------- -- •-------------- ----------- DATE.--- - e Alte�and/or recommendations:_.- _________ __________ ` '-- r s — C'__� ` L�t- ---- --- ----------------------------- ---- a_ -------- � - c' ' .` � `! ' '«C` J`�`"=� ----- ------------ ------ ------------ ---- - 5 :� L ct .. '-C./ '`z. � LP �-�/ � �-+�.�.C�� C F" cam_ �f ---- L� ----------- ---- ------------ �� -- - f` ��` C --------------- a -�-4 `� ryr - _--- = ` 7 -- —` r FINAL INSPECTION BY: �L - -'-�--"- -71 KSAN ,_--- --- _C ` D—ty�.. ��`� � .� ----AQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.0 O.