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,. ,,,7R OFFICE USE: / _-----_-_..__ ---_ APPLICATION', FOR#SANITATION"PERMIT Permit No. . __/_ _`�� - --------- ----'--- ------ {Complete in Duplicate), -------- -- ------- This Permit Expires 1 Year From Date Issued Date issued ________ ___ ,GS Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordiriance No. 549. JOB ADDRESS AND LOCATION...__-�"�?-_________ d ----------- -- -- -------•--------- ------- --------------- V Pho nOwner's Name-----------------------------------------� A - - --e � Address------------------------------------------------------ - -----�� ---- I �-----� t'� ---------------------------------------------- p �jContractor's Name L ----------- ------------------------------------ Phone. ..?... .. / Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel }❑ Other ❑ r Number of living units: _Number of bedrooms__ Number of baths ?-• Lot size -Y-_-L--_T... . _.-- Water Supply: Public system K Community system ❑ Private ❑ Depth to Water Table __ ft. Character of soil to a depth of 3 feet: Sand E] Gravel ❑ Sandy Loam ❑ Clay Loam4 Clay,❑ - Adobe ❑ Hardpan F1 Previous Application Made: (It yes,date_------ --_.--------) NoX, New Construction: Yes ❑ No b4_FHANA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well--,----=---Distance from foundation _lo......... Material__akl -1 ________ __ No, of compartments______.._:__..____Size____I _ �, e---___Liquid depth____-- �.'...____..Capacity}� __ ------I Disposal Field: Distance from nearest well....~`"..._____Distance from foundation._ZQ-------Distance to nearejf ��e__ __ .__.1._. Number of lines_-_____ ___ ______________Length of each line--$O --7.4-.Width of trench.-_ -------------------------- --------- --,__--- ------ !" Type of filter material.__.._._ Depth of finer materia`I---- -� .... length_.__ --so-_--___/______'_. /00_ Seepage Pit: Distance to nearest well ._.____`"-._.--------Distance o foundation---..ffp..._-_.Qistance to nearest lot line_ -- -------- 11 I K$ize: Diameter__ -s�.. .. Number of pits---------------- Lining material_-- _-_- Deptn------ ,�------------- ---- Cesspool: Distance from nearest well-----------------Distance from foundation---------- __.Lining material------------------------------------- ❑ Size: Diameter--------------------------------------Depth--------------------------------------------- Liquid Cap{ cjfy --------------------------gals. Privy:' Distance from nearest well-----------------------___--_---..__----.-.--Distance fror !nearest building. _ _�._______-.__---_____-____.-_-- ❑ Distance to nearest lot line------- --------------------- - -------- - ----------------•-•-- ----------------------------- CL - -------- -- ------- ' --- - - - --------------------------------- - Remodeling and/or repairing (describe � .1.. ..�:---------- y CS T ------------------------------------------------------------------ ------------------------------------------------------------------------------------------•---------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ I hereby certify that I have prepared this application and thaf the work will be done in accordance with San Joaquin County ordinances, Sfate laws, and rules andre ulations of the San Joaquin Local Health Disfrict. 2 r C— Owner and or (Signed} - / Contractor) ------------- ------------;----- ----------------------------- ---------------------- (Plot plan, showing size of lot, location of system In relation to wells, buildings, etc., cant the}__________ ________________ _______,...--_...-..- p g y g , beiplaced on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---- ------------ ------ ----------------- ---------------------------------------- DATE------� - `lia---. - REVIEWEDBY--------------------------------------------- ---- ---------------------- - ------- ------- - -------------------------------- DATE----------------- ------------------------------------------ i BUILDING PERMIT ISSUED------------- ---�----y-----.---------.-s----"-------------_-_ -------------------(-------------------- DATE----------S--�------------------------------------------------ Alferatto�/or recommendations:-----fls� CK -- ------ ---_0-s-------------- L ---------------- @3S_—_, �� -- " ------'fiG' I t„ ------------ - 2 T 1/1 Z FINAL INSPECTION BY:. -. Date---{ _1� - ------------------------------------- - SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Na:elton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.CC. F