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FOR OFFICE USE: - --- APPLICATION FOR SANITATION PERMIT Permit No. .___._1��.__.... L --------------- -_ -------------------3-._3 -- (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__ P - -_� -/ tf'! ' �re,,7.---- '--------------------------------• ---------------------------•-------------- �y `/ ' !.� 3 �'fy_+ `� .iGd1 � '.._ Phone_.. Owner s Name- ---------- - Address---------=�--- � - ----•-------------•------------- Contractor's Name CQ_ C`t ------ Phone----------------------------------- ------------------ Installation will serve: Residence Et- Xpartment House ❑ Commercial ❑ trailer Court ❑ Motel ❑ Other ❑ Number of living units: __/__ Number of bedrooms ,�- Number of baths __ Lot ze��-% -�� _ - 6 Water Supply: Public system *'Community system ❑ Private Depth to Water Table 10-- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe (3''Hardpan ❑ Previous Application Made: (If yes,date-------------- --) No ® New Construction: Yes ❑ No FHA/VA: Yes 59.— No ❑ 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-. s Material ,g,�Ct____Distance from found`a __ yiP-`tion ------ ---- -------- ,/ ® - � apacityA---- No. of compartments-"__C----- ---------- deph- _ �--------------Cf 101 ( 'T _________Distance to nearest low line Field: Distance from nearest well___ ____._._Distance from foundation______ _ f Number of lines------A--------W -Length of each line-_--_Z�__'__ --:--.Width of trench----- ----- ------- ------------- Type of filter material_/ �a Depth of filter material__. r-----kTotal Iength__� ----------------------`-- C Seepage Pit: Distance to nearest well-_Zle_- _-_Distance fro foundation eO----- Dist fnnce to nearest lot line .. L Number of pits_-_A------------Lining mate ria l__ 4---`_.Size: Diameter `- _.---__-___Depth-r _ ' Cesspool: Distance from nearest well-----------------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-- --------- - --------- - ----------------------------------------------------------------------------- ? .�' Remodeling and/or repairing (describe):---------. r`� � --- - ------------r------------•------------------------ ---------------------------------------------- --- -----------------------------------------------------•-----------------------------------•---------- ------------------------------------------------ ---------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin Courifyi ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. /r`' ------------------------_ne-and or Contractor) (Signed) —ee- rCT- �/ ------------------------------- - -- By:---------------------------------------•---------------------------- - --- --- -- - �------------------(Title) - --------------- ------ (Plot-plan, showing size of lot, location of system in r ation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY ----------- ----------------- --------------------- DATE__ `�lF�-� ` � ' APPL'1CATION ACCEPTED BY ----- - - ------ ---------------------- ------------------ - REVIEWEDBY------------------------------------ ----------------------• DATE_------------------------ ---------------------------- BUILDING PERMIT ISSUED----------------------- , , -- - ----------- -------- ATE---- - ---- - /�-"-'--'-- --- - - - - Alte ati s and/or r commendations: ._ K�'N � --, �YL - AZ XT/ ----- ................ ----------------- Date------- � /_=bl--`•g ------------ ------- FINAL INSPECTION BY:......______ ---------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Ma:elton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th street Stockton,California Lodi,California Manteca,California Tracy,California F.P.C O,