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ROFFICE USE:�6FO -- ------------------------- / APPLICATION /7� FOR SANITATION PERMIT Permit No. ...... . _ __ ----- ------------- ---- -----------=------------------ [Complete in•Duplicate) ' - -- - - 'Date Issued _�1.�/� - 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. I This application is made in compliance with County Ordinance No. 549. + . ° DS�_I �I ,(�� r1r J48 ADDRESS AND /LOC�ATION�,I.-_�.��--��_"d /�/ ��"!-�/�--- - - --- -�-' Owner's Name-----1 �-...�/1 { -- --- ---•-••--------- ------�- -"-------------------- - --- Phone--.--------- - ------- Address--------------------•--------•a----------�--�--:-- ------------ =='�• --------- "� �--------------•----------•.......•---------------------------•---- • t Contractor's Name-------- ---- -----------------I=- Phone. Installation will serve: Residence partment House ❑, Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units:._- -- Number of bedrooms _ -- Number of baths _ -- Lot size ---------------------------------- Water Supply: Public system E] Community system El :Private [Depth to Water Table - ft. Character of soil to a `depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam &d Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date--------------------). No,® New Construction. Yes V;�No ❑ FHA/VA: Yes No ❑ TYPE•OF INSTALLATION AND SPECIFICATIONS: (No septic tank or-cesspool permitted if public'tewer:is-available within 200 feet.) Septic Tank: Distance from nearest well-- &Z;--__Distance from foundatio__./v-- .----matej .--..,-.--- Capacity: -.- No. of compartments--- . Size, - __Liquid depth Disposal Field: Distance from nearest well-/��--Distance from foundation_-_,/�_---_-.Distance to nearest lot line--- '..---_- i `f P9�1 Number of lines-----_--�-.-. .�---. Length of each line___-Z5-- -----.Width of french-----«�-- --------------------- op'?° Type of filter mat erial--�y � Depth of filter material--_,,/�-_------.Total length-.-.�41:_r---------------_---_ ;' , Seepage Pit: Distance to nearest well_-- '-------Distanee from foundation_-_/ ---------Distance to nearest lot Number of pits-- - -----------Lining material--- Size: Diameter---SY .--------Depth- 21f--- Cesspool: material f ' Distance from nearest well from foundation---_-------.----_-.Lining material_-..-----.-.-_---------------------- Size: Diameter------------"-t------------ ----------Depth----------------------------------------------------Liquid Capacity.---------------------------gals. p 1 Privy: Distance from nearest well-------------------------------------------------- from nearest building------------------------------_-------. ❑ Distance to nearest lot line---------------------------------------------- --•------ - ------------------- t [ Vill F Remodeling and/or repairing (descrilJe): �_ -- - - - 4;�11 y a -------------------------------------------------------------------------------•------------------------------•-----------------------------•--------•----------------- -------------------- - --------------------------------j_--------------------------.----------------------------------------------------------------------__------------------------------------.-------------------------------------------- _ --------------------------------------------------------------:------------------------•--------------------------------------;-------------------------------- I hereby certify that I 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. Si ned ( /or Contractor) [ g )------------------------A_0� ------- --- - ----- --------- -- = Sy:----------------- •--------------------------------------------------- ------- [Title}-- /� -x----------- --- ------------------ (Plot plan, showing size of lot, location of system in rela ' Fto wells, buildings, etc., can be placed on reverse side). ; k . FOR DEPARTMENT USE ON Y APPLICATION ACCEPTED BY----- ----------------------------------- -----I---- --------------- - -- (-v DATE------ --------------- REVIEWEDBY-----------------------•-------------------- --------- -- ---------------------------------------------------------•--- •- DATE----------. - BUILDING PERMIT ISSUED---------------------------:----:-- -J--- ---- r- - l - ` r - m --------------- DATE-------•---------------------------------------------------- Alterations and/or recomend tions:-:---- --- - - - 1- •-�/�_�- � � - _ ._� -` ~ �-� _ g -�� ------------------------- ---------------- -- �r—t�'- -� ---"_ ----- -= ` / ----- ------ ---------------- -- �•�.- ------------------------------------------ _. --- -------------------------------------------- 4 r FINAL INSPECTION BY:. .........1. .--- .... .. -------- = Date OAQUIN'FLOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California ..-Lodi,California j Manteca,California Tracy,California i E5 9 REWSEO 8-59 3M 3-'S3 F.P.CC. n