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FOR OFFICE USE: 7 ---------------------------------- o-' �< L...� ------------ --------- 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 County Ordinance No. 549. c �r>�✓7'1 Ste` JOB ADDRESS AND LO T((ION------ -VJR-- ��T 1e3_�1 s5 0)------------- ----- -------- Owner's Name------------------ l�r)(S. _PPP; Y1 ------------ Phone � -,�--�-�� Address--------R �c�------13!?�-----er-------------no�_7�_�J�i_ -------------------------------------------------------------------------•--------------- Contractor's Name-------------------------------dw ---------------------- -- --------------- Phone----------------------------------- Installation will serve: Residence ❑ Apartment House ❑ Commercial 0 Trailer Court ❑ Motel ❑ Other El Number of living units:/__----- Number of bedrooms - .._ Number of baths ---'___ Lot size -------A!uav!4�-------------------------- Water Supply: Public system ❑ Community system ❑ Private [R epth to Water Table _ 0 ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam [3--C—lay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date--------------------) No 0--'New Construction: Yes ❑ No/ FHA/VA: Yes ElNo N � ` TYPE OF INSTALLATION AND SPECIFICATIONS: aT eK).s-6mg (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ` Septic Tank: Distance from nearest well_________________Distance from foundation----------------.--Material-.-..-------------------------------------------- G No. of compartments------ ------------------Size-------------------------- -----Liquid depth----------- --------------Capacity------------- ------ 49� isposal Field: Distance from nearest well-------------- from foundation--------------------Distance to nearest lot line_________________ [� Number of lines----------------------- -----------Length of each line--------- ------------------Width of french--------------.--------------------- !(l�7TJ11�r' Type of filter material-------------------------Depth of filter material-._-------------------Total length------------------------------------------ �4 Seepage Pit: Distance to nearest well----------------------Distance from foundation------------------- Distance to nearest lot line----------------- El - _________.__❑ Number of pits----------------------Lining material-----------------------Size: Diameter-----------------------Depth_.------------------------------ Cesspo& Distance from nearest well----------------- from foundation--------------------Lining material__.________--_-.__._____________--- ❑ Size: Diameter--------------------------- ----------Depth----------------------------------------------------Liquid Capacity_--------------------------gals. '+ Privy: Distance from nearest well-----------------------_--------------_----------Distance from nearest building----------------------------------------- Distance - _----____._.______.______----_..__.-_Distance to nearest lot line--------- -------------------------------------------------4-------------------------------------------------------------------------------- Remodeling and/or...iepairin {describe):__RP�k+f`..+ 7lk�n-- -1 .-- 4c�----a!JJ_ --------------------- _ t _ Kc---� ------------------------------ ------------------ -- -------------- --------------------------------- --------------------------------------------- ----------------------------------------------------------------------- ---------------------------- ---- - - I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Statea , and rut nd regulations of the San Joaquin Local Health District. Si ned --------------------------------------------------------------(Owner and/or Contractor) By-------- ---- - - Title (Piot plan, showing size of lot, to ion of system in relation to wells, buildings, etc., can be placed on reverse side. FOR DEPARTMENT USE ONLY �7 APPLICATION ACCEPTED -- --- - -------------------- --------------------------------------------- DATE---- I --------------------------------- - - - - - -- -- REVIEWED BY------------------ ------ DATE----------------- ----------------------------------------- - ------------------------------------------------------------- BUILDINGPERMIT ISSUE -------------- -------- --------------------------------------- ------------------ DATE------------------------------------------------------------- Alterations and/or recommendations--------------- --- -------------------- -----------------------------------------------------•------------------------------------------------------------- ------------------------------------------------------------- ---------------------------------------------------------------------------------------------- ----------------- ------------ --------------- ----------- FINAL INSPECTION ..--- - Date-------------- ° w ?- AN J QUIN LOCAL HEALTH DISTRICT 1601 E.Ha:ellon Avo. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi, California Manteca,California Tracy,California r F.P.CO.