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FOR OFFICE USE: -------------- APPLICATION FOR SANITATION PERMIT Permit No. ------------- ---------------------------- .. D4�at --------------- - (Complete in Duplicate) This Permit Expires 1 Year From Date Issued Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and ipp all the work herein described. This application is made .in compliance with County Ordinance No. 549. 7'oYe/,e -,iso ,. 2E ) 15b-,-(2 i JOB ADDRESS AND LOCATION--�er ------ Owner's Name_ ,` ./, / -- `,------- 1 ------- Phone.93%��.�,�_ r r - - Address----- - -... ' •. pk 7-42---r ---1--,-'leve,-5 -------------------------•----------------------....... ------------------------------------ Contractor's Name > � �----- e4 .�1.5' �_�.rf� S' r - �` ----------- Phone.146l�-9 Q7 i Installation will serve: Residence (' Apartment House [] Commercial ❑ Trailer Court ❑ 'Motel ❑ Other ❑ Number of living units: ---/-: Number of bedrooms -5 Number of baths -;-2.. Lot size .__/--'� `_L�s _____._..______.__._._ Water Supply: Public system ❑ Community system ❑ Private ® Depth to Water Table _ 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 UR New Construction: Yes No ❑ FHA/VA: Yes ❑ NoRl I TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer-is-available within-200-feet.) �:.,_.... /O._�___.Material----._._/_ rf7"----------------- �•. Septic Tank: Distance-from nearest well-_;5'l0_____Distance from_foundation_.____ 7 - Jr p Size G- - Liquid de pth- Capacity_ZRaO._ -Z ` Disposal Field: Distance from nearest well-._._._,Distance from foundation_r75_ ________Distance to nearest lot line______►S__�__ __________.__:_Length of each line_ _`!¢a___�d_,_:Width of trench.___ _ . Number of lines________ Type of filter material__SS,� - Depth of filter material___ r0�__-- Total length-____c Q_---____________________ Q j Seepage Pit: Distance to nearest well_.------ -------------Distance from foundation--------------------Distance to nearest lot line_.___________..._ ❑ Number of pits----------------------Lining material-------- -------Size: Diameter-.----------._.--------Depth-----.-.------.-----------.-.---- P Cesspool: Distance from nearest well-________________Distance from foundation--------------------Lining material__._.____--____-___--_-___-____.-.-. ❑ Size: Diameter--------------------- Depth -------------------------Liquid Capacity------------------------ --_gals. ! Privy: Distance from nearest well._-__------------------------------------------Distance from nearest building. ____________.___ ____------------------- Distance ___ . ❑ Distance to nearest lot line_________________________--- ---------------------------r I ---- E Remodeling and/or repairing (describe):----,/o--- --------------------- - _____. l ,,S7',��____ -------------------------------------------------•-------------------------------------=----------------------•-------------- ------------------------------------------------------------------------------------------------------------------------------------------- 1 hereby certify that I have prepared this application and that the work will be done inaccordance with San Joaquin County ) ordinances, State laws, and rules and regulations of the San Joaquin ocal Health District. ,r---1'71-------- ------ ' ✓ _ .. _ .... --.... :__�+1��. '-=----- - '----- ------ wn r an Contractor) (Signed)----------- BY -------------------------------------------(Title)---- =-- (Plot plan, showingsize of I , location-of-system-in,.relation fo wefts, buildings, etc., can be placed on reverseside). FOR DEPARTMENT USE ONLY ! APPLICATION'ACCEPTED BY= ----------- ---I-- - ------ ' = -..:_=.::-___-------------------------------- DATE-----------=------------- ----------------------= REVIEWEDBY------------------------- ----------------'---- ---------------------- -----------------------------------------_� T`E� ------•----------- BUILDING PERMIT ISSUED--------------------------=-------------------------------------------------------------------------- DA•TE---------------------------------------------- -------------- Alterations'and/or recommendations:----------------------------------------------------------------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------- - --------------------- -------------------------------------------------------------------------------------------------------------•---------- FINAL INSPECTION BY:.__- _ Date----------------1_�_ 4 ----------- -- ,-: - ----- ------ -- -- - SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street J t Stockton,California Lodi,California Manteca,California Tracy,California F.a.Co. ' s - 'l