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FO-R OFFICE USE:} ... L .,. -----------------------------____-------_.___---____- APPLICATION FOR SANITATION PERMIT Permit No. ..L..D-_!..__Sa. -------------- ---------------------- ------------------ (Complete in Duplicate) p ) Date Issued ._ / ---------------- This Permit Ex ires 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 ADDQ LOCATION__h-0------ L ' ----------------------••-------- Owner's Nam - • -------------------- - -- Phone------------------------------------ Address-------- O-,;> � `��,,,,, ----------------------------------------------------------------------------- ------- ----------.... Contractor's Name-__�f 2Lq � �'pr"P .-----"--J �%/r' �'17 G� ft.±. ed - O�Le"i �� °7 ------U------ ----------- ------------------------------. Phone----•---- Installation will serve: Residence ] Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __j__._ Number of bedrooms -3--- Number of baths �=:_ Lot size ---f)-��.-_�:��-_----- - - ------------- Water Supply: Public system ❑ Community system ❑ .Private 0 Depth to Water Table 40_ ft. Character of soil to a depth of 3 feet: 'Sand ❑ Gravel ❑ Sandy Loam.14 Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,d pte--------------------) No �I❑ New Construction: Yes D4 No ❑ FHA/VA: Yes ❑ 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 weil___.50-------Distance from - f-undatio __/Q___ ___-_.Mateial No. of compartments----- ---- --------- fi --- --------------- Capacity-- y'SZ Disposal --- Field: Distance from nearest well-S70------Distance from foundation-_M_ --------Distance to nearest lot line_________________ Number of lines------ ----------- --------------Length of each line------- '�----- ---------- Width of trench--- -=:-----------------___-- YP �� _____ pth of filter material--__. � -----", Total length___.- Seepage Pit: Distanocef tf oenea�estrJwellu.��__----_D s` R' Distance from foundation--------------------Distance to nearest lot line_______________ fb � F1 Number of pits----------------------Lining mate rial-------------------_-Size: Diameter----------------------Depth---------.---..------------_ __ ow O Cesspool: Distance from nearest well_________________Distance from foundation.______---__-._.__..Lining material-------------------------------------- S ❑ Size.,Diameter------ ------------------------------Depth----------------r-------------------------- -------Liquid Capacity- --------------------------gals. Privy: Distance from nearest welt--------------------------------------------------Distance from nearest building------.----______---__________---- ❑ Distance to nearest lot line------------------ : I Remodeling and/or repairing (describe)_------_------------------------------ ---------------------------------------------------------------------------------------------------------- ----------------------------------------- - ----------- -------------------------- ---------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinance$, State laws, and rules and regulation the San Joaquin Local Health District. (Signed)------- 4.__ `-`Tuti ------ -------------------------------------------------- --- -------(Owner and/or Contractor) B --- - -- -- - (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can beleplaced on reverse �. _____ ________ side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -:----------------------------------:'':--- ------------------------------------------ DATE----- REVIEWEDBY--------------------------------------------- --------------------------------'-------------------------•-------------------- DATE BUILDINGPERMIT ISSUED---------------------------------------------------------:------------------------------------------- DATE ' Alterations and/or recommendations: --"------------------------------------ ------ ---------------•------------ -----------•----------------- ------------------------- ------------------------- -------- '. ----------•--------••----- ---------------------------------------------------------------------- -------------------------------' - ------------------- - --- ---------- ---- --------------- ---------- ----=-------•------------- ► FINAL INSPECTION BY:.------ ---- -�-��---------`�- =------ Date---- - -------- •� SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.R00. _ I i