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PR OFFICE USE:------------- _ -------------_------------------------------------------ APPLICATION- FOR- SANITATION PERMIT Permit No:-._.41flf I --------------------------------------- ---------------- (Complete in Duplicate) 1 - ------- This Permit Expires 1 Year Prom Date Issued Date Issued _/A0Z Application is hereby made to!the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Prdinance No. 549. JOB ADDRESS ANDCATION__��r�/J ---------7"_--- - - -r-- �- Owner's Name --------- Address--- -------Address__. �u4 - - --- -- -------- E Contractor's Name____ # -----• --- -� �' s ....... --------- ----------------- Phone..12-- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __/_ Number of bedrooms _Number of baths __-/_._ Lot size Water Supply: Public system W_<o`mmunity system ❑ Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel E] Sandy Loam C] Clay Loam la .❑ Adobe L] Hardpan ElPrevious Application Made: (If yes,dgte--_-----------------) No E] New Construction: Yes Io ❑ 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 Ta Distance from nearest weliF�sf/pistance from fo nd�t ion__!_ 40____--_-Material- -_ -- .y a EEO No, of compartmentsa�4...�__ --___---__Size Liquid de th___��~+_-.- ------Capacity___h _ Disposal Fiel Distance from nearest well_�441—Distance from founda% /�____.Distance to nearest lot lily___ Number of lines_________ _-_ Length of each line___-�V_-f- _ _---------- Width of tranch.c�-r.+-Z- Type of filter materia-___ __-__. p iF Depth of filter material------- - -------Total length-----------------_-- e ------------ S E / Seepage P• .' Distance to nearest well___________ ___Datance from foundation �........Distance�o nearest lot line___[® Number of �#s=- - -------- p• _______________Lining material_____. 4-.Size: Diameter__._�,�_-_----Dep}h---�,�"� __ ..,1 .i } Cesspool: Distance from nearest well-----------------Distance from foundation--------------______Lining material---__-______-____--____-_ ❑ Size: Diameter-- R Depth --- -----------A----------- ---------------------Liquid Capacity------------_--_-----------gals. 1n 'Privy; Distance from nearest we]-------------------------------------------------- from nearest buildin Cl Disfance to nearest lot line. ;_ 9 t 1 Remodeling and/or repairing (describe)----------------------------------------------------------------------------- -------- Sir _________-•------------------------------- y-I'. �F•�F. - ------------------- ------t0 ------------------------------------------ -- i -------------------------------•---------------- ----------------------------------------------- - - G I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County r ordinances. State laws; and rule and regulations of the San Joa uin Local Health District, ti (Signed)_ [ZLd1 �[ LSI • •- -- -� r Contractor) T { I 8Y� E ---------------------- ------- (Title)-------- --- - --- a � (Plot plan, showing size of lot, location of system in relation to ells, buildings, a c., can be placed on reverse side). r- FOR DEPARTMENT USE ONLY ' APPLICATION ACCEPTED BY--- ----------------- ---------------------------------------- DATE__M7-1y---(�?C - ---------------- REVIEWED BY-------------------------------- =rl ---------- DATE ------------------------------ ------------ BUILDING PERMIT ISSUED -------------------- - ------------------------ DATE ----------- ----------------------- �, AIterations and/or recommendations: __-_- ----------------//�/ -: �/__L_ ------------------------------- --------------------------- ------------------- ----------------- •---------------------- ----------------------------------------------------------------------- --------- ------------------------- ------------------------------------------------------------------------------------- ----------- ------------ ----------t''-`......Y---------- - - -- � I . FINAL INSPECTION C� - •- -------- ----- Date..-� - 4 --------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California # Lodi,California Manteca,California Tracy,California F.P.CO.