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FOR OFFICE USE: / O� --------------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. . •Q. � ------ ----------------__---------------------I-- -------- - - (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 constru t and install a ork h regn escribed. This application is made incompliance with County Ordinance No. 549. d S?—�LT�TOro0a, V0 . {\ A) C>>4.ler ✓4 , f�-.OIC 1 `JOB ADDRESS AND LOCAT ONf-'--- —-- -'--+-----e'.._ G - ------"---- Cr's Name--- = ------------------------------------- ------------------------------------ -------- Phone----------------------------------- 7 Address--_��_�_,V•�- ..., I _ ___-- /�/yam)/�J �- _ _�_�dr__/_____________________________________________________________________________________________________ Contractor's Name-------- �/ Phone -------------------------------------- Installation will serve: Residence Apartment House ❑ Commercial ❑ :Trailer Court-"❑ Motel C] Other E] ` Number of living units: _ __ Number of bedrooms__ Number of baths r9-___ Lot size ag:!V-4 _.'_________________________ i f 1911115 r Water Supply: Public system ❑ Community system ❑ Private U� ` epth to Water Tabla ft. Y Character of soil to.a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam P�<lay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ k Previous Application Made: (If yes,date....................I No Z?--'New Construction: Yes gNo ❑ FHA/VA: Yes &—No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: I (No septic tank or cesspool permitted if public se pry is available within 200 feet.) Septic Tan Distance from nearest well Distance fon faundation__, le._.__._Mat�r�l i --- ----- No. of compartments---p ___.__.______.'Size �__` _Liquid dep.th_ � ____--Capacity,AW9_-__ Disposal Field: Distance from nearest weII o,0'Q__Distance from foundation__ Distance to nearest lot line------ of lines___'_____ _ Length of each line_�a.________________-Width of trench..___ ._ _ � �---- _ � u �-------------------- Type of filter materia/ _Depth of filter material_ __.__-_-__Total length_-a �__________________________ Seepage Pit: Distance to nearest well----------------------Distance from foundation---------------_---_Distance to nearest lot line.._____._________ ❑, Number of pits--------------- - ---Lining material----------------- -----Size: Diameter-------------------.---Depth-.------------------------------- Cesspool: Itpistance from nearest well--------------_Distance from foundation--------------------Lining material ...--_-_-.__.-.---__-__---___-_--_ ❑ Size: Diameter---- - ------------- --------------De Depth------ ---------------------------------------------Liquid Capacity - -----------------------gals. r Privy: Distance from nearest well-------------------------------------.------------Distance from nearest building------_---.-----------------------...__._. CA I ❑ Distance to nearest lot line---------------------------- ------------------------------------------•�------------------------------------------------------------ ...... Remodeling and/or repairing (describe) /4g4/--- 4�---&,�--- --------- -�� -tp,; -----------------------•-------------------------------- ---------------------------- --------------------------------------------------------------------------------I---•-------------------------------- ---------- ------------- ------------------- ---------------------------------- -----------------------------------•-------------------------------•-----------------------•-•----------------------------------------------------•----------------------------------- ---- -----------------------------------------------------------------•-------------------------------------------------------- ------------------------------------------ --------------- ------- - ---- 1 I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County t ordinances, State laws, and-rules and regulations of the San Joaquin Local Health District. (Signed) / . - - - - -------- r Contractor] By:--------------i--------------------------------- ---- ------Title (Plot plan, showing size of lot, location of min relation to wells, buildings, etc., can be placed on reverse side). r i FOR DEPARTMENT USE ONLY i APPLICATION ACCEPTED BY----- -------------------------------------------------- DATE--- ---.0--------6.7----------------------- IREVIEWED BY------------x---------`------------ --------- ------------------ -------- ------- -------------------------------------- DATE------------------------------------------ ---------------- BUILDINGPERMITISSUED------------------------------------------------------------------------------------------------------ DATE------------------------------ ---------- - ----------------- Alterations and/or recommendations--------- - ------ -------- ---- --- ------- ------------------------•--------------------------------------------------------------------------------------- --------------------------------------- ----------------------------------------- ---------------------------------------------------------------------------------------------------------------••-------------------------- ---------------`--------------------------------------------------------------------------------------------•----------------------------------------------------- ---------------------- --------------------------------------------- --------------------------- -------------------------------------------------------------------------------------------------------------------------------------------------- FINAL INSPECTION BY: .�t./_ -------------------- Date_.77Z- G7-- -------------------------- -------- ------------ 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 F.P.CO. is