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FOR OFFICE USE: -- ----- --- --- ---- APPLICATION FOR SANITATION PERMIT Permit No. ---------------------------------- ---- t' --------------- --------------------------------- -- (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 d un , This application is made in compliance with County Ordinance No. 549. c. JOB ADDRESS AND LOCATIONJ�t---3------X- 64--- V-g-----------------------''`'� -�"r '" "/' ' - ` Owner's Name t:..1"t: - -�1•--•- -�4 ' "'°a' 1 ---- -- Phone.. 3 =l Address--------- S ! ' f -------------------------------------------------------- Contractor's Name----P /a<: � -s-- ------�.&_4!"------- Phone_- 4 - l d Installation will serve: Residence M Apartment House ❑ Commercial F] Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ---%__. Num_ber of bedrooms _T--- Number of baths -- .__ Lot size -----�--�..-- "�� .-------=•--.-------- iWater Supply: Public system ❑ Community system EI Private h Depth to Water Table _(,� 1- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel E] Sandy Loam 9L Clay Loam E] Clay 11 Adobe E] Hardpan E] Previous Application Made: (If yes,date--------------------) No ® New Construction: Yes ❑ No ®- FNA/VA: Yes ❑ No ❑ TYPEOF INSTALLATION AND SPECIFICATIONS: (No septic tank.or cesspool permitted,if,public sewer is�available within 200 feet.) Septit Tank: Distance from nearest well-------.- Distance from foundation--------------------Material--------- ------------ ---------------------- ❑ No. of compartments--------------------- - Size = ------- ------Liquid depth--------------------------Capacity--------- ------------ _ Disposal Field: Distance from nearest well_ ._J��P_- -.Distance from foundation__`:4__.---- Distance to nearest lot line_-�-J"7------- Number of-lines----------- --Length of each line-------- ---pP .Width of trench-----rp._5G ----_-_--_.-- rn ( Type of filter material--_S GI -Depth of filter materia!-___ -..-_.-----Total length--------,-- --�-------------------.----_ OP T�0.!_.DistanFP to rest lot line---t-�' -! Seepage Pit: Distance to nearest well_-_-_LL----_--.---_ Distance from foundation--- . - I Number of pits---.--f-------------Lining materia124; ... ze: Diameter._tt -.-_ . epth___ "-_------------.--- Cesspool: Distance from nearest well-----------------Distance from,foundation____-----------------Lining material------------------------------------- Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity------------------------- -gals. Privy: Distance Distance from nearest well ---.-.---*--------------------------:----------Distance from nearest building---,----.------.-_--------____------------. i ❑ Distance to nearest lot line -----------------------------------------------------------------------------------=------------------------------------------------------- fs Rt b ° ' - 'a�G' -------•---- Remodeling and/or repairing (describe)----- - ---- ---- ) ---------------•----------------------------------------------------------•-••------ -------------------------------------;-----------------------------------------------------:-.------------------------- ---------------------------------------------•----------------------------- --------------------•--------------------------••----------- -------------------------------------------------------------- --- _{ �[ --------- - ----- ----- -------- ------ ------ ---- ------ ----- - 1. 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 Local Health District. IrSi in d) �'� t s._14� - " ; ---- ---------' (Owner and/or Co 9ntractor) By:---- --- '� t --- ---------------------=--------------------------------------------------•--(Title)___ -- ---- 3. (Pl&_plen,�showinn siz of lat;location-of'systerrt to relation to wells;-buildings;'�etc; can=beTplaced on-feverse-side) C FOR DEPARTMENT USE LY r r r APPLICATIONACCEPTED BY-------- ------ -------------------------------------------- -------- • --l----- DATE----- ---------------------------- REVIEWEDBY----------------------------------------------- ------ --------------- DATE----------------------------------------------------------- BUILDINGPERMIT ISSUED----------- - ----- A•Th---------------------`--------------------------------------- Alterations and/or recommendations:---=� 1-7-�f'--�--= --`--1-f-------------- �� '" "'— l ---------------------------------------------------- - ---- -----1 — - ---------= � ---...- - ---------------------- ----------------------------•-.-- ------•---------------- ---------------------- ----- -- --.--` , --- FINALINSPECTION BY:- - L --------------------------------------------------- Date---- ------- ------- --------------------- --------------- --------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 4th Street Stockton,California Lodi,California Manteca,California Tracy,California Es 9 REVISED 6-S9 3M 3-163 r.R.CC. ...