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FOR OFFICE USE: ----------------- ------------ -- --------------- ._ ._..__.. .______ ________ ___________ APPLICATION FOR SANITATION PERMIT Permit No. .......--------/D..3 (Complete-in Duplicate) ---- - . -.._ ______. __."__- This Permit Expires 1 Year From Date Issued Date Issued Application is hereby made to the San Joaquin Local Healfh District for a permit to construct and install the work herein described. I This application is made in compliance with County Ordinance No. 549, JOB ADDRESS AND -LOCATION---- e / L�, ----"" � ----------------------- -- Owner's Name.---- ----.-_--- _. -----------•-------••-•------•----•- - ---- ---------I----------__------- --------------- Phone_�f_� Address ---------------------------•-----_ ....----------------------------------------- ...-------------------------...--••--------- Contractor's Name "'¢ ..t-�h �' _. + `--------------- -------------- Ph "` Installation will serve: Residence Apartment House 0 Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ... ` -___ Number of bedrooms Number of baths __.____ Lot size_-_�..J_47--tom---------------------- Water Supply: Public system Community system ❑ Private ❑ Depth to Water Tableii /9 ft Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ i Previous Application Made: ;If yes,date..---------,....... ) No ❑ New Construction: Yes ❑ No FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) 5e„ ic,.Ta Distance from nearest well-----------------Distance from foundation--------------------Material .............._____.________-......_.________. . �1.4 :1' "� No. of compartments--------------------•._'Size----------- ---- -----------Liquid depth--------- --- --- -------.Capacity----- ----------------- ii-posald�ih: Distance from near st well ,67P� -Distance from foundation__/____ `.Distance to nearest lot lin '/ Number of lines.--- --- j.�__-Length of each [in e- _- _-_._.Width of trench__ l-._-_-_----- ..4- M' - Type of filter materia 4115-i lk---Depth of filter mate ria l_.j._ _ --------Total length___ .-d----------- Seepage Pit: Distance to nearest well'I*�;D�. .._Distance from f ndation___ --D•sta ce to nearest lot line__--44W_... Number of pits-A-------- . g �_ L f r ___Linin matenaL _.... _ _ Size: Diameter .__..___Depth- ------------------- X Distance from nearest well ______ ________Distance from foundation_._.__......___._ ..Lining material----__-....._--__._________-.___-- 1 ❑ Size: Diameter- - ------------- -------------- Depth---- -----#---- -- ------- -- -- -----------------.Liquid Capacity----------------------------gals. Privy: Distance from nearest well____....._._____ ___-_.___________________...Distance from nearest building------_---.------------------ __-----. i ❑ Distance to nearest lot line-------------------------------- Remodeling ------------------------------Remodeling and/or repairing (describe)____-------____._ .. -----------------------------------------------------------------------------------------------------------�------------------ ----------------------------------------------------------------------------------------------------------------------------------- ------------------ I,hereby certify that I have prepared.this application and that the work will be done in accordance with San Joaquin County ordinances, tate laws, and rules and regulations of the San Joaquin Local Health District. [Signed] q1z,-- -r�k -f. ' -... .. �� -------- ------ ----- ------------ Contract By:-------:_------------------ •--•-------------- -- .- (Title) or] I _ Title - �---------------------- -- ------ -..----------- f [Piot plan, showing size of lot, location of system in rely n to wells, but tc., can be placed on reverse side]. °f FOR DEPARTMENT USE ONLY 1 APPLICATION ACCEPTED B ------- --- - - ---------------------------------------- DATE f�-_-- -3 "0 ---------------------------------------------------------- - REVIEWEDBY-- --------------------- -------------- ---- ------- ----------- ---- ------------------------- ------------ ------------ DATE- BUILDING PERMIT�ISSUED----------- - -------------------- -- DATE--------------------------- C ---------------------------- --- --- - Alterations and/or recommend ations:--- - -- -----..--.71----------------------------------7.-_r A---------.-----------___.-- t ----•-------------•------------------ ------------------- --- FINAL INSPECTION BY:----- --------- Date-.- - � `F' y SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazollon Ave. 300 West Oak Street 124 Sycamore Street 20.5 West 9th Street Stockton,California Lodi, California Manteca, California Tracy,California . anguard Press