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FOR OFFICE USE: ""F " - ---------------- ------------------- ----------------" -7 p ._.__-____._____ ------------------------------ APPLICATION FOR SANITATION PERMIT Permit No. ..P % (Complete in Duplicate) -------- ---- This permit Expires f Year From Date Issued i Date Issued _ -6/7 Application isrhereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This applicationis made in compliance with County Ordinance No. 549. 1 �� r JOB ADDRESS AND LOCATION.__ fb_S-4.Cc6_"_ .�.-- - -•- 1 - "�- - ---- •------- ---------------'----- Name .-- ---------- Owner's ► Address �x cs°�1 Contractor's Name_S.J FI �? 8. Phone---=--- --ovgl-�----/ --- ' ---'---------- --Zeo�------ Installation will serve: Residence( Apartment House [] Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _.(-__ Number of bedrooms __.__ Number of baths _?___ Lot size .__ ._ --% "g______________ Water Supply: Public system ❑ Community system ❑ Private V] Depth to Water Table -------- 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--------------- ----1 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 Tank: Distance from nearest well_-`1✓`�" _------Distance from foundation____�l -_` Mafierial_---. F3NGl '�� z: No ofcompartments____ .-.,'� .- .`___Size____I -f7a74'_--- Liquid de th'�s' -------- - - Disposal Field: s Distance from nearest well._-_?(,j Distance from foundation___/0. _ Distance to nearest lot line----ZO_ _7F-5 --V -- - - - 'i } Number-of lines_"-� -.p ___Length of eatH—Jine='_'-Q'f '� Width of trench. rt Type of filter material t�.-c> 1 ..--Depth of filter material------ ------------------------ ------------------ Total length___-_/ --._______________ Seepage Pit: Distance to nearest well___ ( Q.-_Distance/ fro foundation________-Distance to nearest lot line__` 0...�_ (7 ONumberiof pits...__._ .. Linin material!_f _Size: Diameter__..__ _ _ r p �' ! *4f -----Depth--./cf----------------------- Cesspool; „' Disfence from nearest well__./CD. __Distance from foundation--.� -_.....Lining material___________________________________ ❑ i Sfze:,Diameter--------------------- ------ ----Depth-------- --------------------- ---------------------Li uid Capacity q --'-- --------------------gals. Privy: ,'`•Distance I!fromnearest well _____________-----------------------------------Distance from nearest building ❑ Disfance to nearest lot line--------------------------------------------- - Remodeling and/or repairing (describe):"__4:c-v----4Z r c --------------------------•-------------------------------------------•-- 4 ft-'---'------------ ----------'-----------------------------'1-- ---------- - --------•--------------- ---------'- ------------------- -------- - hereby certify thaf have prepsied this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, acid rules and regulations of the San Joaquin Local Health District. (Signed)---0' I<- rs - ' t. , s ' �-- �- ----'- - - ---------- "--_-"_____-.(Owner and/or Contractor) RY== _.- ------ ------------------- --- � --- --'- ------- ------ (Plot plan, showing size of lot, Iota 'o " of system in relation to wells, buildings, etc., can be placed o reverse side). FOR DEPARTMENT USE ONLY APPLICATION Ai EPTZD BY-------•--------- DATE------------------------------------------------------------ REVIEWED BY �'�'' ►-� --------. --- ' DATE -!-3—- ---�------------------------•------- BUILDING PERMIT ISSUED-------------------------------------- ---- ---------- DATE------------------------ Alterations and/or recommendations_----------------------------- ; ----------------------- -------------•--------------------------------------------- -------- -----------------------------------------------------------------------------------------------------------------------------------'-'----'---- ---------- �� ----------------------------------- ,..:� -A� FINAL INSPECTION BY:.. ------- bate---�l' � SAN JOAQU LOCAL HEALTH DISTRICT 1601 E.Maxelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,carifornia