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., _ AFI E USE: - I- -------------- --t-- ------- ----------- ---- - -------------------- x-------------------- ---------------------- _ �-_ ---- APPLICATION — SANITATION PERMIT No,. f Duplicate) Date Issued __lete in Du (Com This Permit Ex fres 1 Year From Date Issue _ _ .0 pp / r � �� - 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. ff -7 JOB ADDRESS AND LOCATIO l--Q O ..._.-.. ( � '+ ..-�-------------------------------- j Owners Name _!�iv��, __---k A4 Q_ Phone " Address ---------- ----- --� � / ��7- � W -Contractor's Name-----I-------- -- - I- t- 1- --.----------------------------------- ----------------------- Phone..4 ----_ __ Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ___[___ Number of bedrooms -2,--- Number of baths --/--_ Lot size .... ---- --1.1:Z--_-.--_----__-_.___ Water Supply: Public system X Community system ❑ Private ❑ Depth to Water Table -//a 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 P<- New Construction: Yes ❑ NoX FHA/VA: Yes ❑ Nog 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 .___._.....__.____.__--_...________.__.._______. ❑ No. of compartments--------------------------Size-------------------------------Liquid depth-------------------------Capacity... :.;-------------- Disposal Field: Distance from nearest well-----------------Distance from foundation--------------------Distance to nearest lot line-- ----_-__ ❑ Number of lines-----------------------------------Length of each line------------------------------Width of french--------------------------------- Type of filter material---------_-----------------Depth of filter material----------------------- length--------------------.._-_-____-___-_-.--_- 0 Seepage Pit: Distance to nearest well____________________ _Distance f o fou dation-- - �0_�____.Distance to nearest lot line__J��_-_i_._ J p _____Lining material___ ____,Size: Diameter-_--.- _ rDepth-- � r of its--��------- � ^�—I' ` 1 -- ------ �-�----------------------- V% 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 repairing (describe):____._._- jI_-_t.�---t------ -------(rte_---' a ------------------•------------------------------------------------------------------------------------------------------------------------------------------- -------- ------------------ ----------------- �► ----------------------------------------------==-----------------------------------------------------------------------------------------•--------------------------- - - - -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- 1 hereby certify that 11have prepared this 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. lr-�Pr- j � (Signed)------------------------------ - -��-j�f� - L�_- ------- - (Owner and/or Contractor) -- ----- BY: ---------------------- --------- ----- ------±- - ---------------------------(Title)--- �4----- ............ . --.-- ` (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----- -- --- ----- ----------------I-------------------- ------------------- DATE------ s REVIEWEDBY-------------------------------- -------------------;- ------------------------------------- DATE - BUILDINGPERMIT ISSUED--------------------------------------------------------------------------------------- ----------- - DATE------------------------------- ----- ------ --------------- Alterations and/or recom end tions ------- ----- - --------------- ------------------- .-dP. -------- --------------------------------------------•----------------------------------------------------------------- --------------------- -------------------- ------------------------- ------ { FINAL INSPECTION BY:- �.��.-------------------------_--__._--_-- - - Date--- -=--4-7770P---7-19-4� ----�-�- SAN JOAQUIN LOCAL HEALTH DISTRICT 7601 E.tfaselton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.C o,