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FOR OFFICE USE: ---------------/ - . a ------------------------------------------------ --- APPLICATION FOR SANITATION PERMIT Permit No. If75.. . ------- ----- ---- --- -- ----- (Complete in Duplicate) .___.___ 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- ctomp��anch County Ordinance No. 549. JOB ADDRESS AN LOCATIO -- ---`-- ---ear gw4v __----- 9_.__zA 444_.....o,I---�y _______�K_ Owner's Name------- _,/ •-' "�r�1� f :_ -�' = = - Phone Address ----------------- ----- -- -- - - - -- - s Contractor's Name------- �- ------------------------------------------------------------------- Phone----------------------------------- Installation will serve: Residence R�—Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __/__ Number of bedrooms___ Number of baths .9L_-_ Lot size .. _ i -00 '______________________________ Water Supply: Publics stem Communit system . �" pp y: y ❑ y y �ivate ❑ Depth to Water Table �_ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel [] Sandy Loam ❑) Clay Loam ❑ Clay ❑ Adobe Gg--'F1`aF�Jpan ❑ F Previous Application Made: [If yes,date.__._-..---,.-_.__-,) No 2-""New Construction: Yes 2'No ❑ FHA/VA: Yes [4--�No ❑ f TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) �f iSeptic Tank: Distance from nearest wceelll-__---�______Distancer from foundation-__XPf.__-_-MatUial--�� a__- -- i No. of compartments_.,.?__------------______Size�Y,[� Jl_'��___Liquid depth__.4�.._.. --------Capacity__1XA.iW----- Disposal _-__ Dis osal Field: Distance from nearest well. _.__�+ Distance from foundatio.__ '� 1 p ____ r ��Q-....-._.Distance to nearest Pot line _____.. Number of lines---- _.�`___---- Length of each line-A0- ____________Width of trenchy._ ______ Type of filter material Depth of filter material_____ Total length__!_� ________________________ Seepage Pit: Distance to .nearest ywe[l____-_=---------Distance fr m fo ndalion--- ��------_Distance to nearest lot line_�'____-.__-- [b� Number of pits__.o�_.___.._..._ Linin material__ ._ . _ _�-Size: Diamete /� " { - g - - = r�-�--------�----Depth-±�e�.--��'7 ---- Cesspool: Distance from nearest Weil_::_..r'^"--_"°'-Distance--from-foundation -r�:.._.Lining material________________________________ j' ❑ Size: Diameter-- .........Depth------------------------------------------------ Liquid Capacity---------------------------Egals. Privy: Distance Distance from nearest well--------------------------------------------------Distance from nearest building--------------------------.----- Distance to nearest lot line----- ----------------------- --- - ------- ------------------------' ( �. Remodeling and/or repairing (descibe) `,��ly ! f _. p -------------------------------------- ------ Y""-"" -- --•-•--- ----•---------------------------------------------r-------------------------------------------------------------------------------------------- ---- -------------------------------------------- ----------------- ----------------------------------------------------------- i --------------------------------------------------------------------------'--- ---------------------- -------------------------------- ti :---------------------------------------------------------------------------------------------;------------------------------ ------------------- -------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County Vordinances, State laws, and rules arsd+regulations-of-the-�San-Uoequin*Local-Health-eistrict (Signed)------------------------------:------------ l (�or Contractor) IBy:---------------------------------------- --------------------------------------- ---------------(Title)--- ��--------- -- ----- -------- [Plot plan, showing size of lot, location of system in rely n to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT US;i QNLY APPLICATION ACCEPTED BY----------- -�� ---------------------------------------- ----------------------- DATE- -----&/, F`REVIEWED BY---------------------- ---------- ------------------------ ------------------------------------------------------------------- DATE----------- - BUILDING PERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE Alterations and/or recommendations-------------------------------------------:-------------------------------------------------------------I--------- -------------------------.------------- 1 --------------------------------------------------------------------------------------------------- --------------------------------------- --------------------------------------------------------------------------------- --- ---------------------------------------------------------------------------------•- ------------------------------------- t I ----------------------------------------------- ---------------------------_. --------------------- ------ - ------------------------------------------------------------------------------------------------------------------- ---- -- -------------------------- -------------------------------------- 'i ----------------------------------------------------------------------- -------------- ---------------------------- -----------------------------------------------------I-------------------------------------------- FINAL INSPECTION BY:------..... ------------------ ---------- Date-------------------`f1.1 31 ff`Y---- SAN JOAQUIN LOCAL HEALTH DISTRICT 1801 E.Hazelton Ave. 300 West Oak Street :� \124 Sycamore Street_. 205 West 91h Street Stockton,California Lodi,California Manteca,California j Tracy,California F.p.Cfl.