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FOR OFFICE USE: - -: -- .- -hcr f - 1__ 1.r_--______-___�o_Q- -._ APPLICATION FOR SANITATION PERMIT Permit No. ------------- ----------------------- ------------------ (Complete in Duplicate) Date Issued --------------------- ----------------------------- This Permit Expires 1 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 descrtied. pp P y . 549. ..�i�voj) ---------------------- TION �„ This application is compliance)fiance wi}`Q` Ordinance o------------------------------------------ ------------------------------•-••--- JOB ADDRESS �� ! Owner's Name---------------— �_----.--- �'Y C:`' Q ------------ -------- ?'/Y ......... ... . Phone_!!?-�/9 :--- Address------------------------- / f .:... _Y/ - ------- ------------------------------------------------------------------------------------- Contractor's Name------ 1 '� �---- Q/ll .• � �f�---- ------. Installation will serve: Residence []"Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living unifs.: Nuenbero bedrooms.. -_Number_of_baths Lot size ---- ------------------------- Community -- ------------- ----- �ommunitY system El Depth to Water Table ....- ft.Water SuPPIY� Public system ❑ } Character of soil to adepth of 3 feet: Sand E] Gravel ❑ Sandy Loam E] Clay Loam ®2<lay E] Adobe❑ Hardpan ❑ Previous Application ade: (If yes,date--------------------) No ❑ New Construction: Yes No ❑ FHA/VA:Yes ❑ No 0— TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic fanK or cesspool permitted if public sewer is available within 200 feet.) I Septic Tank: Distance from nearest well-----------------Distance from foundation------------- ------Material---..----------------- ------.--_-.------------ . i osal field: Distance from nearest will___. _�___.-Di q - t_-.Distance to nearest lo ❑ No. ---%t------- ' ---Si stance from f undation u��de th-------------------------- a ac+ y of compartments---------- t�line-�•�-._.._ D sp ,� �____----__-Length of eac line---:-_.----___-_�--��_►.-.Width of french ' Numbest of,lines--..-- --_-_______ . sr4 ': / �^ e /.. c Type of filter material--- fry�-----Depth of filter material__,---- ---1--Total length------ -f�rf _-/..-Q--------- TyP& r i / --- ^� Istance to nearest well_.----_�_ _.-._--DistanceX*11;� foundation- to to nearest lot line-`---`�---.-- , ]� . ,tuber of pias,k_/-------------Dining material-- _-Size: Diameteir ---- .---------Depth--- �___----------_ Seepage it: Nli. � � f } Cesspool: Distance fromnearest well-----------------Distance from foundation-__-.---- Lining material---.___-..-._--.-------:_.--___----- r, ❑ r Pa_Liquid Capacity gals. Priv Distance •from nearest well--,'----------------_- ------.--___..-..------___Distance from 'ne Size: Diameter... � ------- ---Depth- -------------------------- y s I crest building------------A ------------- line ---------- - r ❑ Di"stance to nearest lot line ---•-- ------------ ----------------------------------------•-- ------ '"r C ' 1..- `f _-TIt:T_ ,.- ,1 --------•----•------------------- • Remode4ing and/or r pairing (describe): ._-_--______ __ ------------------------- ----------------- ------------- 1" --------------------- -------------------------------- ------------------- i ---------------------------- ------ ------------------------------- -------- ------------------------------------------------------ --------- ------------------ i ! hereby certify that I have p5epared this Pplication and that the work will be donelin accordance with San Joaquin County I ordinances, Statelaws'i and rules $nd regulations of the,4 San Joaquin Local Health District. Si ned * -- ----------- -----� L ----- -- - r-�r ---------------- .,Owneand/or Contractor By: "+ [ ------------------- -------- (Title)------ -+...--------------------------- (Plot Plan, showing size of lot, lo c ti sof.system�in=relafionfo�welis.,6uidings,,.ef.c.,rcan b6 placed on reverse side). FOR DEPARTMENT U5E ONLY, APPLICATION ACCEPTED BY-- ------ /G4-C ---- ------------------------ -------- ------- DATE -------? r --------------------• -••------------- REVIEWED BY- --�---�------------- '----- - --------------------�-- ---------- ----------- -- --�--------)------- DATE-------------------- BUILDING PERMIT ISS _ - ------- - -�------_ � _____ Alterations and/or recommenda?ions:---- - ----- - - ----- ------------------- ---- - ----------------•------------------- ---------------- -------------- ----- ,n v ' 7 -- -----------------� 2 may' �u -` _r f1 ` --------------------------------------------------------------------------------- ----------- -------- ------------- ............... ------------------------------'-------------------------- --------------------------------------------------- ----------------------- ------------------------------ r f FINAL WSPI=CTION aY:. °------ A C ='_. .. -------- Date------------ '` y ��`1�----------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California