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FOR OFFICE USE: ' - ------------------=------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) Date issued --//_—_1Y_ - --------------------------------------:----------------------------------------------------- This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Healfh District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. P� .> I JOB ADDRESS AN LOCATION_ I _ Y4:__.-_ �- _•______-_____ P .. , Owner's .Name _ ----------------------- �}- one Address--------- ------- - KL�fi Contractor's Name--.--,- a t�-`"r 1 ...... Phone----•-------•---._-----------•--•- Installation will serve: Residence Apartment House ❑- Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ___/__ Number of bedrooms___ Number baths/- ---- Lot size _______________- ------ - ._-------------- Water Supply: Public system E] Community'System ❑' Private pth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adore❑ Hardpan Previous Application Made: (If yes,date---_------- ________) No ❑ New Construction: Yes ❑ No 0 FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cessp'aol permitted if public sewer is available within 20Q feet.) Septic nk: distance from nearest well .._____�6stance ~��foundation-..--/19.}h--Material----_ .2-Zo -a—{-��--_.-_------- _.______Distance to nearest �` No. of compartments-------------- *Size_- _-.- q p p y Dispos Field: Distance from nearest well Q..--_ Distance from foundati9�__1__4.__ lot line__________ ______ tJ Number of lines-------- -----------' -- Length of each line------ ----------_-----.Width of trench.--__ -�--•-___.--=------ -- N rr t Type of filter material___._4?;_� -�--...__Depth of filter material -___-.-.Total length____.�d______________________________ Seepa Pit: Distance to nearest well-----/IE ------Distance from foundation------ _P_�.___.Distance to nearest lot line_.__�.1_______ p g - ---- M Depth_a.r---------------------- Cesspool: ------------------- - Number of its._._--_-`�'______.Linin material 1`� Size: Diameter____ . - �2 Cesspool: Distance from nearest well_________________Distance from foundation___---------.-------Lining material-------------------------------------- ❑ Size: Diameter----------- --------------Depth---------------- ------ --------------------------Liquid Capacity----------------------------gals:-•tet Privy: Distance from nearest well------------------------------------------------ from nearest building ----------------------------------------- ❑ Distance to nearest lot line-------------------------------- - - ------ - ------------------------------------------------------- M Remodeling and/or repairing (describe):_.. __ - ----------------------- -- - ---------------- __ - -- -------- ------ ------ ------------ ------- --------------------------------------------------------- ------------ --- -- - ---- --- -- --------- -- - ry_f 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 rules and regulations of the San Joaquin Lecal'Health,District. (Signed) ;- -------------------------- a _ and/or Contractor -- - .nF. �-_ � � r4_ .!^�r�-i�r �,.� �-.'-��w"r�r�.r.�s� �-•�r....w�r- + -+ter- •r� _' .d By------ -------------- ---- ----�--- - - - -- -------------------------- t _Title __ -- - - - - --- - ------ (Plot plan, showing size of lot, location f system m relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ------ -- ---- -------------- -------------- I -- ------------------ DATE-2P7�'-��-�------------------ ---------- REVIEWEDBY--------------------------------------------------------------------- ----- ------------------------------------------------ DATE ------------------ BUILDINGPERMIT ISSUED---------------------------------- -------------------------------------•---------------------------- DATE_.---------------------------- ------------------------------ Alterations and/or recommendations:-- --- ------ -------------------- -------------------------- -------------------------------------------------•------------ -------------•-- --------•--------------------------------------------- ------------------ ------- -------------------------------------------------------------------------------------------------------------------- -- ------------------------------ - ---- -----------------•-------•--•---------- -- ----------- ----------------------------- -----•------ ----------------------- FINAL INSPECTION ---- i 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.RCO. J.1