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FOR .FFICE USE: P/,?_� 1W-------------- f.. ---_- . APPLICATION FOR SANITATION PERMIT Permit N,0;__/ / Z �- �{` �_------ (Complete in Duplicate) ------- ------ ------------------- ----- -- - - - - ---------------- ---- - , /, bate Issued �f-- _F_!/. ------ ,Q_--. This Permit Expires 1 Year From Date Issued e- �icjsf�on is he eb'y made to the San Joaquin Local Health District,: r a permit to construct and install the work herein described. T is application is made in compliance with County Ordinance No. 549. I JOB ADDRESS AND LOCATION------------ -------------------------------------------------------------------- - --•------------ Owner's rf IA144�,___L/,---- tw ize� , Phone-- =Addr - -- -------- ess---------------•---- ' Phone-------------------••-------------Contractor's Name IT , Fk Installation will serve: ResidenceApartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _--/_ Number of bedrooms Number of baths _ __ Lot size __ ___ .___ - ------------------------ Water Supply: Public system . Community-•system-El—Friva-te'E—Depth-to Water•T-able .�7ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam E] Clay ❑ Adobe rdpan ❑ Previous Application Made: (If yes,date_---_----------------) No [:f'---New Construction: Yes ❑ FHA/VA: Yes E]_ No J�j_ TYPE OF INSTALLATION AND SPECIFICATIONS: I (No septic tank or cesspool permitted if pubtic sewer is available within 200 feet.) Septic Tank: Distance from nearest well---- '--�Distance from foundation_ ---Mat r-al.�vIC_ ,�.--_______- l [�� No. of compartments---__---�-------------Size----- ---_C�__-Q-_Liquid ep.t------ Z17 ---------Capacity____ p /___--- Length of each line........ Distance to nearest lot line- ------------- Dis osal 'e d: Distance from nearest wl!ell_� stance from foundation------ Wid T e of filter material _ ____ 1�6 th of,filter mafa ial__ ,_ �( , tai n trench___._o .-y----___-_-______ Nucrlber of lines-------- __ - -- e ----_. �� i---- -Tota! length ---�`-r�--l-------------------- p g f See a e it: Di#ante •toinearest<welL_ stanc� �ro� founds Ion- __f--- Distance to nearest lot line ---_-.-_ �o c-_ Number of 'pits----- Lining mater a1_ / � ze: D ameter3. /.__..-___Depth 5�Cesspool: Distance Distance frdhi1 nearest:well_____.___'-_-Dista ce from fevndation....................Lining material--------- Size: Diameter -------=------------------- Depth------------------------------ -------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well----------------------------------------------- _Distance from nearest building--------------.---- ----_. fi ❑ Distance to rico - rest lot line------ --------------------------------------- -- --------------------------------- --------- ---- , Remodeling and/or repairing {describe':-------- �_ ------•-- _ ---------------- ------------------- - _----_--- -------•-- L` ---------------------------------------------------- ------------------------------ ------------------------------------------------------------------------------- ----------- ------- -1--------- -------------------------------------------------------------------------------------------- -------------------------------------------------------------------------------------------------- ----------- - r t --------- ---------------------------- ---------------------------------- -----------•-------------------------------------------------------------------------------------------- ---------------------...... ... ! hereby certify that I have prepa�ied`+Nis application and that the work will'be-done'in accordance with San Joaquin County ordinances, State laws,' and u es nd regulat' ns o he San Joaquin Local Health District. 1 (Signed)----- {_---_:`.---' -.--- ----- -- ."�""_ --- --- (Owner and/or Contractor) 1 1 Title --- - --- -- By-------'---- `------.------------- - -- ---! -- ( +,. } - (Plot plan, showing size of to , station of system in relation to wells, buildings, etc., can be placed on reverse side). t FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY--------- ----------------------------------------------------------------DATE--- � -------------------------------- REVIEWED BY--------------- --------- --------- - -- -------------- --------------------------- ------ DATE ------------------------------------------------------------ BUILDING PERMIT ISSUED--------- --- --- =- ---------------------------- --------------------- ----- -- �1 * -- - ATE-•. AI#eraa r recom en at"ons: _ _- _-----------: ---------------------------------------------------------- ------ -- _---- I 9 ----------- ------------------------ -------------- --------------� 1--- - -- -- -- - -- ----- ----- i FINAL INSPECTION BY:-- - ` ---------- -- ---------- -JOAQUIN LOCAL HEALTH DISTRICT-- Da S N �j , 1601 E.Haxelton Ave. 300 West Oak Street , '124 Sycamore Street 205 West 91h Street Stockton,California ?Lodi,California 1 . 1 anfoca,California Tracy,California T r•.P.co. -�