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FOR OFFICE USE: , II APPLICATION FOR SANITATION PERMIT pp Permit No. _.I_...��. _-_- ------------------ - ----------------------------------- " - (Complete in Duplicate) /P:��. Date Issued ____-- 0- _. -----------------_- This Permit Expires 7 Year From 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 compliance with County Ordinance No. 549. JOB ADDRESS AND LOCAT! JI... V--- �P `� 5 ��' -`'�-----.D_- rv�irx' - . 0 AJ ll_ , . Phone-•---- �D Owner's Name----------- ---t------=., -'�__/�_�_----------------------- ------ -------------- -------- ---- � �-�-�- - -- Address----.....--•------------------- � -----��---------------1 11�.....---�'.1--�-�---------------------��4__,O�f---------------------------•-•--•---------------------.....- -- Contractor's Name---------- _7 �' Phone. �� ^� -------------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ I� Number of living unit --_ __--_.__ Number of baths --- --_ Lot size ------ ----------------- ----------------- s: __p Number of bedrooms � Water Supply: Public syste,i ❑ Community system E] Private [b��epth to Water Table _ t. Character of soil to a depth.of 3 feet: Sand [] Gravel ❑ Sandy Loam ❑ Clay Loam [j-'Clay ❑ Adobe❑ Hardpan (j 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.) Septic nk: Distance1 from nearest welLfa- _. _Distance from foundation__ _____.Materia!___-L. ! ''! ___________ No. of compartments------�---------------Size- _-_E�__--------Liquid depth-----�`".�._`--._------ Ca acit a�� _ � • l� f -T�_f_..__Distance to nearest lot line_ Disposal Field: Distances from nearest well,) ____-Distance from foundation._ �� Number. f fines___________f__ _.___ .____..___Length of each line---- Q__- Width of trench-. 1G______________________ 0 Type of filter material- _ •± i�Depth of filter material- f ___.__ . Total length_----.,�-42- - -----------------_._. Seepag Pit: Distance,to nearest well - -- .--____ istance frgrn foundation_____.�----_------.Distancce to clearest lot line__ Numberlof pits_.''"'`_- .._ _,.. ._ _ r --------Lining material Diameter---�-- $ ------------ ------Depth____-. -V-_j---.---.----.- Cesspool: Distance from nearest well-----------------Distance from foundation------------------- Lining material�-------------------.__---.---..----_. f ❑ Size: DiNmeter------------------------------ ----- Depth--------------------- --:-= ---- - ------ --------Liquid Capacity--------------------------gals. Privy: Distance) from nearest well------------------------------------------------- from nearest building------------------------------------------- - ❑ Distance; to nearest lot line----- - -------------- - ----- -- - ----------------------------------------------------------------------------------- Remodeling/ d or repairing�(d�"cribs]:_______..-._____ _f._ C_ _��/� _----_d7—//----' --------------- ---`-" '' �•�---------- .rl`' i r�� ------------- --------------- �M. ------------------------------- A- ----------------------------------------------------------------------------------------•----------------------------------- I hereby certify that I F ave prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, an mules and regulations of the San Joaquin Local Health District. -----------------�er and/or Contractor) ,., (Signed)---------------------------- /��i`�f-5�------•�� -�----------- ----------------- - u (Plot lan, showin size o lot, location s stem in cele+ion to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY 1 APPL1CATI0N ACCEPTED BY ---11� - -- --- ----------------------------------------------------- DATE----�°-------- ------ ---------------- y= REVIEWED BY---------------------- -------- - ------------------------------- --------- -------------------------------------- DATE------------------------=-------- -------- -------------- BUILDING`PERMIT ISSUED)---------------------------------------------------------------------------------------------------- DATE--------------------------------------- --------------------- Alterationsand/or recomm ndations:-------•---------------------------------- --- ------------------------------------------------------------------------------------------------ ------ ------------------------- ---------------- ------------- - --------------------------- --------------------------------------------------------------------- a_. SII --------------------- ------------------------ -------------------------------- ----- --------.------------------------------------- - --- ------------------------- ---------------- FINAL INSPECTION BY-' ---------------- Date_.. ----------- rra SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 @.Hazelton Ave.; 300 West Oak Street 124 Sycamore Street f' 205 West 9th Street 1 Stockton,California Lodi, California Manteca,California Tracy,California i ' F.P.r O.