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fOR OFFICE USE: iWA X36 -� -- --------------- APPLICATION FOR 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 �C/ounty Ordinance No. 549. JOBADDRESS AND LOCATION---------------?`-4-----------t -/---------4?- -----_------------------------------------------------------------•------------------------------- S --AdOwner's Name-------- f�D�I��-•��1--------------------------- •---------------------- -------------------------------------------------- - Phone__!McSr- 43'---------------- Address---------------------------- dress-----••------------------------- _S�7 ' E ----------------------------------------------------------- ------------•------------------------------------•-----------. . _..---------------._.. 671 !- DPhone. - yCZContractor's Name . Installation will serve: Residence [g Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: 3-___ Number of bedrooms A_57�- Number of baths __a-- Lot size __l,c?b'___.K_J_40-1----------•----------_ Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table -k-oft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe �K Hardpan ❑ Previous Application Made: [if yes,date--.--------,....... I No� New Construction: Yes ❑ No FHA/VA: Yes ❑ No E 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---------------------Material----_____-__._._____-___-__________..._____-___. ❑ ( ,;a No, of compartments--------------------------Size--------------------------------Liquid depth --f-------------------Capacity---------------------- Disposal Field: Distance from nearest well._1�P"_Distance from foundation---1_P__f_;_--__Distance to nearest lot line----+r--______ Number of lines-------------1--------------------Length of each line----_-__---- of trench.......... ----------------- Gl. Type of filter material o I�-:_Depth of filter material____ s__.-Total length_______________ -------------------- Seepage Pit! Distance oto nearest well---N..efY_�----"Distance from foundation_____1_O_11:___ Distance to nearest lot line__..____.--.. (% 0-(l Number of pits-----_1_____________Lining Size:7 Diameter._..-33..-_._.__.Depth--------- '_--__.-___._ Cesspool: Distance from nearest well_________________Distance from foundation...._._..-----------Lining material------------------------------------- ElSize: Diameter-_- ----------------'t--------- Depth--=----------- '- ---- -- -1�--------- ------Liquid Capacity----------------------------gals. Privy: Distance from nearest well-__________________ --------------.............. Distance from nearest building----------------------------------------- ❑ I Distance to nearest lot line------------------------- --------- -------- ------------------------- - I Remodeling 'and/or repairing (describe):----- 1----&0-i�?---- - ------------L -X I C-7/1t4 G--------`S--`S-77 -----•--------------- ------------------------------------------------ �.y -------------------------------------------------------------------- - - . ----------=----•--------------------------------------------------------- -------------------- ----------------------------------------------------- ---- ----------------------- --------------------------------------I hereby Certify thatl 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)--------------� -- --- � ---`--�_ ----------------------------------- •----- -------------(Owner and/or Contractor) ] '�` - - --------- -------------------------------- n be placed on reverse side]. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED ------------- --------- ------ BY-- - '.:---------------------------------------------- DATE -1-'rJ- x REVIEWEDBy--------------------------- --------------------- - -------------------------------------------------------------------------- DATE----------------- ----------------------------------•------- BUILDING PERMIT IS U - - - --- - DA TE. � -- 64 t a -Alterations and/or recommendations:---- -- ' ---------- ---- ----••---- -------------•-------------------------------- 4 .. r k .. ,. . i. ________________________________._____l_,_i__'___i__S_3r;_ _'_-__�_ __�________________________________________________ -----------------t ------------------------ --------------------------- 1 10 ---------------- -----------------------------------•---------- ----- ---------------------------------------------------- . - . t - — --------- - ----------- - ------------------- FINAL INSPECTION Date----------------- r , a SAN JOAQUIN LOCAL HEALTH DISTRICT k 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.C C. 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