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FOR OFFICE USE: --------------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. . --. --------------------------------------------------------- (Complete in Duplicate) — qq ------------------__-----.----------.-------------------- This Permit Expires 1 Year From Date Issued Date Issued ----G.. Application is hereby made to th!l�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„�/=- - .rr -- --------------------- ------------�--------------� ----------------- Owner's Name------- �l - CI C/// L-� r+��V Phone ��7 •-•- � _ Z — �--- - `Address---- 7 =, -- ------- - -= ---- ------ / 7 f2 Contractor's Name----- ! --• � ' _ --------------�7 `' o --------------------------.-------- Installation will serve: Residence 0 Apartment House ❑ Commercial ❑ Trailer Gm, .g Motel ❑ Other ❑ Number of living units: --- '_ Number of bedrooms .- Number of baths ---(--_ Lot size ------ .- --- ..................__........ f Water Supply: Public system ❑ . Community system ❑ Private X Depth to Water Table/_7A__ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ ' Clay ❑ Adobe Hardpan ❑ Previous Application Made: (If yes,date-_-----------------) No E],-` New Construction: Yes U2--<o ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool;.permitted if public sewer is available within 200 feet.) Septic Tank: Distance from'inearest well----f-0----Distance,from_founcd�atpn--.- -U f.-..Material.,, ----------------------------------- No. �----- -------- ------- _--. p s �X / .Liquid depth---------�------ ---Capacity_l'- No. of com artments--__:_,_-__7.-______-_Size--� � -.--_ Disposal Field: Distance from ;(nearest well__-f... .-.-Distance from foundation.----1'9_ -.--Distance to nearest to line-------fir Number of lines-------------'7----.--__- ......Length of each line__-----1_1e-______Width of french------ - -___--- -----.- Type of filter material-__ r ��'-��Depth o£ filter material-_--.-r-�_-__,-_Total length_________ ____�-.._--_------__---�--. Seepage Pit: Distance to near st well l-�.. ---Distance from foundation------ _v_-.-_-.Distance to nearest lot line--s-`-----. {dumber of it;.-- ruin material----- ---_!C�ize: Diameter----- -- Depth--- - 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 to nearest lot line-----------------------------------------------•------------------------------------•------------------------------------------------------- Remodeling and/or repairin (describe):_---------- � �2 -i'r �' -y�-. n--------- ---_----�� cw---- --------,--- / - -- -- ---------------- ----------------------- ! -::------ --- ------------------------------------------------------------------------------------------- ----------------------------------- --------------------------------------------------------------------- ---- -- - -------------- I. 1 hereby Scertify laws, andrules have pandregulations the San Joaquin as othe Locallth work HeaeDistrctn aaccordance with San Joaquin County ordinances, tate (Signed) ........... c� -------- -t ------ -------------------------------------------------------------(Owner and/or Contractor) By--------------------------------------------------------------------------------------------------------------------------------------(Title)---------------------------------------- -- - - (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---------- f a t DATE , ;�. �� REVIEWEDBY----------------- ----------------------------------------------------- ----------- ------------------------------------------ DATE------------------------------------------------------------ NG BUILD(ons PERMIT r ISSUED ndations: -(-. i! -------------------------------------- PATE---------------------------------------------- ------------- and/or �� ........... ,T/------ r GL-.---- ------------------------------------------------------------ 4 ------------------------------------------------------- -------------- ----------- ----------------------------'-------------- ...... --------�--------------------------------------- ------------------•--------------------------------------------------------------------------- 4 FINAL INSPECTIONBY . Date-------------.57-":�. SAN JOAQUIN LOCAL HEALTH DISTRICT P 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street - Stockton,California Lodi,California Manteca,California Tracy,California s F.P.CO. d 1