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` FOR OFFICE USE: ---------------------- APPLICATION FOR-i-SANITATION PERMIT Permit No. ---------------------- ---------- ------------------------------ -------- --- (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 described. This application is made in compliance with County Ordinance No. 549, JOB ADDRESS AND LOCATION _ _ ------------ -------�----�� --------------4 . ----- Owner's Name-------•---------- '- 9�1I.. _.- -------------jjoj�-------------------------- ----------------- ----- Phone-----•------------------------------ Address------------------ ----- 1--4.6------••--S--------• .rw,.l A G ----------�J ---•-------------------- Contractor's Name--------------------------- •----------=-------------•---------------------------------------------------------------------------------------- Phone----------------------------------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _A_--- Number of bedrooms _- — Number of Baths ---I---- Lot size _______' .1---�C__� �--- Water Supply: Public system ❑ Community system ❑ Private N` 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--------------------I No ❑ New Construction: Yes34 No ❑ FHA/VA: Yes ❑ N o 17 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-------50---Distance from foundation----L()--- -C :�_______________------------- No. of compartments------------- --- ---Size--------t ------.Liquid depth--------------------------Capacity..- - Disposal Field: Distance from nearest we]-------5_0.-_.Distance from foundation____',%__._..Distance to nearest lot line__f-------------- XNumber of lines--------------------------�Z_____Len th of each line------------ ----------Width of trench--------------- Type of filter material-__-_-1.1T_-.tkw1„ Depth of filter material_.___ ---- --Total length------_1- _____ Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line----------------- 0 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------------------------------------------------- from nearest building--------------------.-_____-------.-___.-- ❑ Distance to nearest lot line-------------------------------------------------------------------------------------------- ----------------- - ---------------------------- Remodelingand/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. (Signed)- 77.-)---,----------�- -�--- ---Ae------- --�------- .................. .... . --------(Owner and/or Contractor) - $ f : ” ;m:: (Title)-- Y (Plot plan, showing size of lot, location gfAystem in relatio owe -lls, buildings, etc., can be placeddXnreverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------- --------------------- DATE_. �E ------------------------ REVIEWED BY-------------------------------- - - ---- -------- DATE BUILDINGPERMIT ISSUED------------------------------------------------------------ .. 1---,� "`'-------- DATE--------- ------------------------------------------------- ----- - ------------------------------ Alterations and/or recommendations:--------_-------------------- - -------------- ---------- ---------------- }' r'" --------------------------------- ------------------------------- •--gid. --------- ------------------------------------------ ----------------- ---------------------------------------------- ------- - ----- ----------------- ----------------------------------------------------------------------------------------------------------------------------- FINAL INSPECTION BY:..__ Date------ �-�/--�- ------------------------------------ SAN JOAQUIN LOCAL HEALTH DISTRICT i 1401 E.Hasellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street r Stockton,California Lodi,California a; Manteca,California Tracy,California = F.P.ru. 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