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FOR OFFICE USE: - 1 --- ------ -- --------------------___._..__.__......!w_____. APPLICATION i=OR SANITATION PERMIT / Permit No. .. ---------------------------------------- (Complete in Duplicate) _ e ___,__J�_. 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 install the work herein described. This application is made.in kcompliance with County Ordinance No. 549. A—1 ted: JOB ADDRESS AND OC o i �O ; ' - `-�- �` -It-- 111-- -PJi------------------ ----- Owner's Name__-_________ ` � _VZ -------------------------------------------- Phone--------------------------- Address----------------------- ----1441-4?r--- 7 Contractor's Name �p - •----------------------------------------- -------------------------- ----•--•--- ------ Phone----------------------------------- Installation will serve: Residenc+e� Apartment House ❑ ommercial ❑ Trailer Court ❑ of I ❑ Other E❑ Number of living units: _ 1.---_ Number of bedrooms ___umber of baths __f___ Lot size ______ _E ___________________________________ M� Water Supply: Public system ElCommunity system ❑ Private K Depth to Water Table - -_ ft. �I Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe'N Hardpan Previous Application Made: (If yes,date____________________) No Y New Construction: Yes No ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION!!AND SPECIFICATIONS: / �[No sepfic tank-oresspool-permittedAf public-sewer,is-available-within.200 feet.) SeR i� Tank: Distance from nearest well _____.__:Distan ,from found ion__ __, _FJ Mate ia!__.� 1 i _--__-M1 . li No. of compartments________________________Size__'�_r___ _ �i_r_S__Liquid depth___._._�!'.'._____-__Capacity___��.Z.?�__ p I Field: Distance from nearest well--- .v-----Distance from founda .€o .__.'?. Distance to nearest of line. .____... ©i Number of lines_______-? ____ ----.____r Length of each line_ _ U_ ___.Width of french_.. _ !_ -f_________________ Type of filter material-J-T! .Depth of filter material-_______ _ __if_______Total length_______ _ .__i' _______-___________ Seepage Pit: Distance to nearest well------ ---------------Distance from foundation-------------------Distance to nearest lot €ine_..__________._- V ❑ Number` of pits----------------------Lining material-----------------------Size: Diameter--------- ----Depth----------_---------------------- Cesspool: ----Cesspool: Distance from nearest well________________Distance from foundation-------------------.Lining material___.___..______________-.__________--- ti ❑ Size: Diameter--------------------------------- ----Depth-------- ------------------------------------------Liquid Capacity-----------_---------------gals. _. -Pi•ivy:� Distance from nearest well--------------------------------- _______________Distance from nearest building-_.____________._________---_--.-- - ---�.._. ❑ Distance to nearest lot line--.- ----------------------------- Remodeling and/or repairing (describe}--------- ----- ------ -------------------------------------------------- -----------------------------------------------------------------------=- -IM' -------------------------------------------------------------------------- ----- 11 ----------------------------------------------------------------------------------------------------------------- ------ -------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------•---------------------------------------- I hereby certify that V eye prepared this application and that the work will be done in accordance with San Joaquin County ordinances, St to laws, andi rules and regu€ati{(Ts of the San Joa u Local Health District. (Signed)-- `------- -- ----�� --------------------------------- -- ---------------------------------------- ------ ----------------------------------(Owner and/or Contractor) Plot Ian, showing size of lot, location of system i •. Y' ;, - Tt e ( p g y n relation to wells, buildings, etc., can be placed on reverse side). 'k FOR DEPARTMENT USE ONLY ,I APPLICATION ACCEPTED' BY----- -------------------------- -------------------------------------------------------------- DATE REVIEWEDBY �p ------------ --------------------------------- ----------------------- ---- ---- DATE BUILDING PERMIT ISSUED-i---------------------------------- ----------- DATE- v-------------------- Altera#ions and/or recommendations: - 1 -----------------------------------••-----------•----------------- -----------•------------------------- ---- ----- ---------- --- .i`-------------•----------------------- _ -------------- --------•--------------------------------------------------------------------------------------•--------------- -------------------------------------------------------------- •------ --------- ---------------------- j---------------••----------------------------------------------•------------------------------------- --------- I �E a FINAL INSPECTIY:I v k - - --•----- ------------------------------- - Date------ O �"U�-��(.��y-..------------------------------ - - Iw i SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.fla:elton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9Th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.0 o.