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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. -------------- --- -------------------------------------- f . (Complete in Duplicate] Date Issued -� _'E��* ---------------------------------------------------------:._ 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 described, This application is made in compliance with County-Ordinance No. 549. JOB ADDRESS AND LOCATION--F-V1---_-f) --`�--��---�----------- /&/-..---��---�-- -•----- -------------- � �®' Owner's Name....._ . ._ l -- ------ =- ----- -----------------------------:.-.-.._ Phone------------------------ Address- _._[.r.-- f-� �- ----/3-��----..,qtr{ a------ f ---------------------- ------------------------------------------------------------------------------------- - i 71 Contractor's Name - -4_.. S —5 -------------------------------- Phone----------------------------------- Installation wiil serve: Residence ['Apartment Houie ❑ Commercial ❑ i Trailer Court ❑ Motel ❑ Other ❑ t 9s r . Number of living units: .-l... Number of bedrooms .>,3..- Number of,baths -�.-- Lot size ...........�._'Q�.................................. Water Supply: 'Public system ❑ Community system❑ Private Eff Depth.to Water Table ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ®�Hardpan ❑ Previous Application Made: (If yes,date------------ - -----)t,No [�New.Construction: Yes �o ❑ FHA/VA: Yes ®moo ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted,if public sewer is available within 240 feet.) t ` t t . ! Septic Tank: Distance from nearest well.-�r-0..-.....Distance from foundation---/0.___.._..Material--------------- ---------_--.------------..-. No. of compartments------ . — " - �- -- - - Size--`-�--9---x-�-�--3�--- Liquid depth ---- Capacity./Loo-�---- Disposal Field: Distance from nearest well...r t.........Distance from foundation.-./a_-........Distance to nearest lotlines-- ----- [ Number of lines------Z-------------------------Length of each line.mkt.- ---------------Width of trench--Z.1-- ------ ----------.-- Type of filter mate rial__/74.C._ff-------Depth of filter material.' .............. length-------%z-4.s.. .---------- I Seepage Pit: Distance to nearest1well..1,06 ---.--Distance from foundat --- to nearest lot line_S r Number of _ �h its___ ©� P --------------Lining material--- Diameter--3_ ---- .--_--Depth---- -----------.--.-- I Cesspool: Distance from nearest we!€-----------------Distance from foundation._._----------------Lining material.._____._.-._...-..-.-.._..._------- ❑ Size: Diameter. `------------------ ---- Dept -----------------------------------Liquid Capacity--------------------------gals. Privy: Distance from nearest well-----------------------------____....._-.-....Distance from nearest building----_-----.-------------. ❑ Distance to nearest lot line---------------------------------- ---- - --------------------------------------------------------=--------- -------------- ------------ Remodeling and/or repairing (describe):-----------------------------------------------------------------------------------------------------------------y-------------••---------------------- ----------------- ------------------------------------------------------------------------------------------------------------------------------------- ---------------------------•-------- ------------------------ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State I s, and rules and regulations of the San Joaquin Local Health District. (Signed)------------- = C � '`�. '� ------------------------------------------- --------------------------------- ------- -----(Owner and/or Contractor) By:------------------------------------------------------ -------------- -------- ---------------- -- -------------- -- -- ---- --- ---------------------4 ----[Titl'e) --'�- ......... . (Plot plan, showing size of lot, location of system.in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY i APPLICATION ACCEPTED BY ----------------- ------------•--------------------------- DATE ------ ----_ --------------- IREVIEWED BY------------------------- ------ - - --------------------------------- - . DATE--------------------=--------- BUILDINGPERMIT ISSUED---------------------------------- --------------------------•--------------------------------------- DATE------ ---------------t---------3. Alterations and/or recommendations-------- ------- --------- ---------------------------------------------•----------------------•-----•-----------------`--------------------------------------- f --------------------------------------------------------------•------------- ---------------------------------- ------------------------------------ - ---------------- ------------------------------- FINAL .INSPECTION BY:.-_' i�"- . � ------ ----•-.--- Date...-7.--- �. - --------- ------------------------------------ l 4 SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street stoektonr California Lodi,California Mantecar California Tracy,California F.F.CO.