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FOR OFFICE USE: ------------------------------------------------------- - ---------------------------- --- ------------------------ APPLICATION FOR SANITATION PERMIT Permit No. _a.—Z)Z . _.... -------------------- -------------------- (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 in I the wor ler in described. This application is made in compliance with County Ordinance No. 549. r}/� 3 n3 N• per. L16fIEs JOB ADDRESS AND LOCATION' Owner's Name- ----- �f_� ��a �- ----- Phone. Address---- fes ° =-1--------- > d ----------------------•-------------------------•-•------------ Contractor's Name------------/_465C�� Phone Installation will serve: Residence ®Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: I___ Number of bedrooms-5--- Number of baths A_._ Lot size .14W" ___________________ Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table.eft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: Ilf yes,date--------------------l No PR' New Construction: Yes R fVo ❑ FHA/VA: Yes 9�-- No ❑ a TYPE OF INSTALLATION AND SPECIFICATIONS: ('No septic tank or cesspool permitted if public sewer is available within 200 feet.)-- + Septic Tank: Distance from nearest wel{__�C-�_Distance from foundation---/40--------Material-. _ ---46 r4-f-_" No. of compartments-_.-* ___________ Siza tquid depth__-_-/_ ......___...Capacity/. � - Lm � s c Disposal Field: Distance from nearest well-.Vr ... Distance from foundation__�_O________-Distance to nearest lot line_________________ Number of lines---- _ Length of each line_ -------------------Width of trench. ------------------------------ filter - ------------------------- Type of filter materialepth of filter mater3al__f .._______Total length_. __---------___________ !. Seepage Pit: Distance to nearest well----------------------Distance from foundation____________._.._._.Distance to nearest lot line---------------.- (� j ❑ Number of pits----------------------Lining material--------------------.Size: Diameter-----------------------Depth' ----------------------------- {]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)------- ------ ---- ------------ -----------------•------------------------- ------------------------------------------------------------------------------------------------------------------------------------:-----4 --------------------------------------------------------------------------------------------------------------•----------------------------------------------------------------------•------------------------ --------------- -----------------------------------------------------•----------------------------------------------------------------------------------------------------------------------------------------------------------- ----------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rule and regulations of the San Joaquin Local Health District. (Signed) __ ___( er or Contractor) �� ' Title(Plot plan, showing size of lot, location of system in re n to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY--------- ------------------ ---------------------------------------- DATE------- ------------------------------- REVIEWED BY-------------------------------- DATE------ ---- ------------------------------------------------ BU I LDI NG PERMIT ISSUED-------------- /-- -- ----- DATE----------------------------------- -- Alterationsand/or recommendations:------- ---------------------- --- --- --- ------------------------------------------------•---•-------•---------------•--------------------------------------- ----------- - ---------------------------------------------- ----- - -----------------------------------------•---------------------------------------------------------------------------------------------------------- 07 FINAL INSPECTION BY:...��.:.Jl Date- --- .w ..5�..-. ---- ----------- --------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazeltan Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy, California F.P.C CL