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--- ---- - -- -----ROFFICE USE: 7�7 --- -- - - j APPLICATION FOR SANITATION PERMIT Permit No. __A9r-- �-r._ ---------------------------- --------------------------- (Complete in Duplicate) ------------------------------ This Permit Expires I Year From Date Issued Date Issued 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 ante No. 549. (EC7`: JOB ADDRESS AN CATIO / = --------- ---- --- `"�` ` Owner's Name •Q r--- f- ------- ---- i�l'� e-----•-----•------------------------ �q Address ------------ ------- ---s -------------- Contractor's Name----------- ,/�/ -r, ._/!1 �` =------------------------------------------------------------ Phone.-I. -0•eK wp-; j Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other Number of living units: __----- Number of bedrooms -------- Number of baths -------- Lot size -_- _4ti _��... ................. Water Supply: Public system ❑ Community system ❑ Private ZDepfh to Water Table/5—ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam [,Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: {If yes,dote............. --) No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) r r Septic T nk: Distance from nearest well__-____Distance from foundation_,/,G�----------Material___ --------------- No, No, of compartments-- ---- -------- - _ Liquid ....r.. .......Capacity_�,ZV -4- ------ Size-f Disposal Id: Distance from nearest well-✓�D----._Distance from foundation_1Q_1-------.Distance to nearest lot line94.1 ,_e_ Number of lines-_._------_CLength of each line___ /_4f_4?_'`____---_-Width of trench----- "__._.____.____ Type of filter material_- D - " g , Yp .pG/_�_Depth of filter material _____________Total len th__.1�,Q._�________._.__________ Seepage Pit: Distance to nearest well----------------------Distance from foundation------------------- Distance to nearest lot line----------------- F-1 Number of pits------- --- ----------Lining material----------------------.Size: Diameter.----------------------Depth------ ------------------- ---- 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 an /or repairing [describe]: leu „�• -"k...-------f `' �............. d� -------------... ----------------- G - = ------ ----- -- - -- ---------------- ----------------------------------------------------------------------------------------------------------------------•---•------------------------------------------------ ---------------- - - ----- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State la , n ru s and regulations of the San Joaquin Local Health District. {Signed} �� / -5 { ��'" r -- ---------- w rand/or Contractor) gY= .. Fs-----------------------------------------------------(Title)----- '---------------- -- - ------ (Plot plan, showing size of lot, location of stem in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED i3Y e _- ----- ---------- DATE------��-`--Z_ - ------_ - REVIEWEDBY--------------------------- ------- -------------- ------------------------- ------------------- --------------------------- DATE-------------- ------------------------•------------------- BUILDINGPERMIT ISSUED------------------------------------------ ----------------------------------------------- ---------- DATE------ ------------------------------------------------------ Alterations and/or recommendations------------------- --------------------------- ----------------------------------------- ----------------------------------- ------------------------------------------------------------------------------------• ------------------------ •-------------------------------- ----- --------------------------- --- ------------------------------- --------------------------------------- --- ------------------------------------------------------------------- - ------------------------ FINAL INSPECTION BYt__..-.._ � 7 -� -__-._-- --_. ....... 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.CC. A