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FOR OFFICE USE: - ----------------------------------- ------------------- ----- --- ----- ----------------------- APPLICATION FOR SANITATION PERMIT Permit No. ---------- ...... --------------------------- ------------------- ---- --- (Complete in Duplicate) ------------------------------------- This Permit Expires 1 Year From Date Issued Date Issued Joaquin Local Health District for a permit to construct Application is hereby made to the San u t and install the work herein described. This application is made in complianceWith County Ordinance No. 549. JOB ADDRESS AND LOCATION------- Owner's Name--------- ----------------------1/1-------------- --------:............... ----------- ------ Phone---------------------------------- Address �Z ------------------------ -------------------------------- ----------_------------------ -S�Cap - P -------------------------------------------- --------------- Contractor's Name-----------D.Z--- -------__ .42 --------- ..... Installation will serve: Residence M-"A/partment House 0 Commercial E] Trailer Court El Motel ❑ Other L] Number of living unifs-6 Number of bedrooms Number of baths Lot size --------------------- Water Supply: Public system -0 Community system El Private n Depth to Wafer Table -------- ft. Character of soil to a depth of 3 feet: Sand 12 Gravel E] Sandy Loam E] Clay Loam El Clay [] Adobe[] Hardpan-C] Previous Application Made: (if yes,date ----------;------ - No [t-- New Construction: Yes E] No ©—IFHA/VA: Yes El No Ei.,, -TYPE OF INSTALLATION AND-SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well_________________Distance from foundation--------------------Material------------------------------------ -- ---------- El No. of compartments----- - ---- -_----------Size-------------------------------Liquid depth------------------------- Capacity------ ------------- ; . Disposal apacity------ ---I---------- Disposal Field: Distance from nearest well.-----_____..._Distance from foundation--------------------Distance to nearest lot line----------------- El Number of lines-----------------------------------Length of each line------------------------------Width of frencA--------------------------------11- :1 Type of filter material_________________________Depth of filter material-_t-------------------Total length_______ _____________--___________----. V > t Seepa Pit: D;sfa e to nearest well__/,,Z-�5--------Distance frc)m foundation_-_-;/0----------Distan/ce to nearest lot line_,Zv Number.of pits.---__.L__-.----_-Lining material- Size; Diameter-03! ........D,pfh__,.__Z Cesspool: D�sfan`c'e from nearest well-----------------Distance from foundation--------------------Lining material------------------------------------- F-1 Size: Diameter-------- ---------------Depth---------------------------------------------------Liquid Capacity- --------------------------gals. Privy: Distance from nearest well------ ----------- ------ - --------- ----------Distance from nearest building.___------_-.____.__________- j ❑ Distance uilding-------------------------------- Dis"fance to nearest lot ---line----_-_----- ---------------------------------------------------- /7-- Remodeling and/or repa�ring (describe):____.- __ f/. �rimC ---- ------ ----- ------------------- -------------------- --- -------------- -- - ----- -- -- I ....0-------- ---------------------------------------------------------------------------------------------------------------------------------------------------------i- ------------------- - --------------------------------------I-------------------------------------------------------------------------------------------------------------------I-------------- -------------------------------------------- ----------------------- --------------I------------------------------------------------------------------------------------------------------------------11---------------------------------------------------------- ---------- I hereby certify that I have prepared'fhis application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of.the San Joaquin Local Health District. ------------------49- (Signed) A.... __PA_ RRI,4 ......... 4'e-1--------------------- - --------- --------------Lam-----------------(Ownpr and/or Contracfo'r) . . By:------------------ ------- --- ----—---------------------------------------- (Tit l)_,_,�...... - --------------------------- (Plot plan, showing size''of lot, lova ion of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY ,# 7i� APPLICATION ACCEPTED BY____,� ------------------------ -------------------------- DATE.___,�_,------------ - REVIEWEDBY--------------*------------------- --------------------------------------------- ------- --------------------------------------- DATE------------------ BUILDINGPERMIT ISSUED------------------------------------------------------------------------------- -------------------- DATE-------------_---- t, — ----i---------- Alterations and/or recommendafioni-.-_7._'_----------------------------------------------------------------------------I------------------------------------------------------- --------------- ................... --------------------------------------------------- --- -- --------------------------------------------------------------------------------------------------------------------- -------------------- ---------------------------------------- -------- - ------------------- e•k------ ---------------------------------------- ------------------------------------------------------------ ------------------------------------ ---- -- -•--------•------------ -------- ----------- --- ------------- -------------------------------------•------ ------------------------------------- -----------------------• ------ --------- ---------------------- ----------------------------- --------- - - ----------------------------- --------------------- ---------------------- ------------- --- -------- ------ ---------------------------- FINAL INSPECTION ...... .............. . Date_./ --- A SAN 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 F.P.C 0.