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FOR OFFICE USE: "�f _ - 6 ------------J_!, --31P----- -- 9 O0____- APPLICATION F(5k- SANITATION PERMIT Permit No. _._ �.. - ----------------------------------- -- -------- ------ (Complete in Duplicate) Date Issued ----------------------------------..------_----------,_ 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. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION----' - /"(>lw_ .__ rs f�' `==---------------------------------------------------------- Owner's Name---; !®�- r 'E"�t�cAfr�_---- Phone------------------------------------ , Address--------„ �----_------------------------•--•------ -...---------•----------------....-----------------------------------------..---•-----------.....---•----------------------•----- Contractor's Name------------ Q-__Ar _zeZ---------- --------- ------ Phone.-----••------------------------- Installation will serve: Residence 21"A-partment House ❑ Commercial [] Trailer Court ❑ Motel ❑ Other ❑ Number of living units:_._.- Number of bedrooms ._>_ Number of baths +T-__ Lot size cs,%,_j ----------- •--------------- i Water Supply: Public system El Community system El Private �epth to Water Table 41r ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 2--nardpan ❑ Previous Application Made: [If yes,date.:................ .I No J?'�New Construction: Yes ❑ No go.- FHA/VA: Yes ❑ No r TYPE OF INSTALLATION AND SPECIFICATIONS: C (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tanks Distance from nearest well--__.._.--------Distance from foundation--------------------Materiel-.._._.._-_.-..... ---------- ,Utl t'f No. of compartments-------------------% ..Size--------------------------------Liquid depth-------------- - -----Capacity----- --- k Disposal-Field: Distance from nearest well...4i rV__----Distance from foundation--_,1_-.------Distance to nearest lot line,_-_....- ` Length of each line.. .. ,., YP ber of lines---------- _` � / .�� -�� `Width of trench. ---------•-----------t C� T 'e of filter material 6�� _� 1 _Depth of filter material-�---------------Total length.� s�+�� .).-_ _- Fre Seepage Pit: Distance to nearest well Distance' from foundation--&iP------.Distance to nearest lot liner___..... S' i Number of pits.../.--------- Lining material__Ae� .Size: DiameterIr ._..110 ....Depths --- ----------------- Cesspool: Distance from nearest well------------------Distance from foundation------------------- Lining material--.-.._-...___._...-.---------___--- S ❑ Size: Diameter-------------------------------------Depth----------------- ---------------------------------Liquid Capacity-------------- ------------gals. 6 Privy: Distance from nearest well-------------- -----------------------------Distance from nearest building-----------_-----------------------------. I ❑ Distance to nearest lot line--- ---------------- - - --- ----------k------- --- ---------------------------------- I � G Remodeling and/or repairing (describe): ------ - ---- ------------------------------------------ "1 -------------------------------------------------------------- --------- ------------------ --- 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 a d regulations of the San Joaquin Local Health District. Y g (a (Signed) �1, -------- ------ --- ------------------ -------------I' * Contractor) B _ (Title) ----------- - - -------------- Y•-----------------------------------------------•------------------------------------ --- (Plot plan, showing size of lot, location of system in relatio -wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY----------------------- G-�--------------------------------------------=----------- DATE--------....X�- r r�� -----------•-----_ REVIEWEDBY--------------------------------- ------------------------------------------------------------------------------------------ DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED ---------------------------------- ------- DATE----------------------------- ------•---- ------------------ Alterations and/or recommendations:--------- �...-_ `T �>.... � 9c-- -------•- ------------------•--------------------------- ------------------------------------------- ----------------------------------------------------- ,+------------------------------------------------------------------•---- ----- --- ------------------------------------------------------------------------- ---------------------------------------------------------------t ----------------------------------------------------------------------- -- --•-- -------------•-- - ------ ----------------- FINAL INSPECTION BY:..---` - ' -- Date. f G�--- S N JOAQUIN 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 r5 F.PM0.