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N FOR OFFICE USE:,,, ; APPLICATION `FOR SANITATION PERMIT Permit No. ..c2.1 ,51" ----------- ------- - -------------- ---------------- -------- - ------------------- --------- (Complete in Duplicate] I ----------- -- Date Issued _--- ------ This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for 8 permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. -------- ---------------- Owner ---- ---- JOB ADDRESS AND LOCATION___ 1-_-d6.K-----�1 G- ------------ /' `------- -- Owner's Name------- - -- = .r ..� ------------- -------- -- --------- Phone----1- 3 1 -� C Address------ k C ' ----- Contractor's Name – 1 ------ Phone-�V_6---y----1--a 7 k Installation will serve: Residence 'Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __/____ Number of bedrooms 4--- Number of baths _x___ Lot size --------------------------- Water Supply: Public system ❑ Community system ❑ Private gDeptb to Water Table Zq- ft. 'Character of soil to a depth of 3 feet: Sand [travel ❑ Sandy Loam ❑ Clay Loam [j Clay E] Adobe E] Hardpan ❑ Previous Application Made: (If yes,date----------......- ..) No 2 — New Construction: Yes ❑ No [!I'FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: i (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well--- Distance from foundation-__%A___-_____.Material_______ __ ________________________________ No. of compartments-----.Z----------------Size-- --x`�-_x`J3- _Liquid depth----._ V---------------Capacity---l�d-- r _. a f Disposal Field: Distance from nearest well-,J-_b__-----Distance from foundation_--e_!_-_____.Distance to nearest lot"gine_ _,-_....- ©� Number of lines------..A-------- - -'- -----Length of each line--------r-Q--------- ----Width of trench------�-----t*------------__-.._ - Type of filter material____ Depth of filter material____.l_Y--r..__--Total length_____L_z_ ..__-________________ I Seepage Pit: Distance to nearest well------.---------{-----Distance from foundation___________________.Distance to nearest lot line----------------- ❑ Number of pits------- ---------r---Lining material--____-_.--------------Size: Diameter-,--:------------------Depth--.------------------------------ Cesspool: Distances o`m nea'res#; 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------------------ -----Y----------- ------------------------- ------------------------------------------------------------------ Remode4ing and/or repairing (describe)________________________ .i '� --------------------------- - -----------•----------------------------------------_--- -------- i t I 1_� . ------------- -----------------------•---------- = ----- ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- I hereby certify that i have prepared this application and that the work will be done in accordance with San Joaquin County i ordinances, State laws, and rules and regulations of a San Joaquin Local Heath District. J (Signed)------ ---- ---:� ----------------(Owner and/or Contractor) -------- By--------------------- ------------------- --------------------------------------------------------(Title)------------------ (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 APPLICATION ACCEPTED BY... .....'_ --= -- _ v --------------- DATE---4�7/_ - ----------------- 1 REVIEWED BY------------------ -------------- ---------- ---------------------------------- DATE----------------------------------------------------------- BUILDING ------------------------------- --BUILDING PERMIT ISSUED-------- -------f- = - ---- DA-TE---------------------------------------------------------- Alterations and/or recommendations:._-- <K ----- - ----------------------------=---------------------------------------------------------------------------------- t ------------------------------------------------------------------------------------------------------------------------ ---------------------------------------- --------------------------------------------------------------- -------------------- ---------------------- -- ---------------------- --------------- -•------------------- ��_ , FINAL INSPECTION BY: f� ------ ----- bate_.... SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hosellon Ave.. 300 West Oak Street w 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.co. F 5