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�v>< vrrlL.t uSt: W -------------------- ----------------- z' ------ APPLICATION FOR SANITATION PERMIT Permit No. ------ -------------------------- -------------------- (Complete in Duplicate) .� - This Perm It Ex fres 1 Year From-D e Issued Da#e Issued - A5 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. 544. JOB ADDRESS AND LOCATION-. r - _Y_3 F/0 r Owner'sName ' ----J----L•- f � -Y ---------------- ------------------ 6- ---------. Phone---V -`! -I1 AddrAs---------------- •- 5`� :c a�c.�-�a^- Contractor's Name---------- �{ ' s' ----------------------- --- -------•-------------- ------ Z- ----.. Phone------------ serve:will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other Number of livin units: __I--- Number of bedrooms --- -.. Number of baths _1.___ Lot size ._____-__- "..__- ❑ g Water Supply: Public system ®• Community system ❑ Private ❑ Depth to iWater Table C-� ft. Character of soil to a depth of 3 feet: S-and [_1 Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe E" Hardpan ❑ Previous Application Made: (If yes,date_____.__.--- ------) No E-- New Construction: Yes ❑ No [4]- FHA/VA: Yes 0 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-H%± Distance from foundation-----/4----------Material__- v+/ Q a No. of compartments------ --------------Size---- _x 5_--x------•--_Liquid depth------Y.'.... ___"- _Capaci#y__ foo Disposal Field: Distance from nearest welL.AQ �-_-Distance from foundation___!6_____._____.Distance to nearest lot line_-; �_"""""_• l Number of lines_______ " "-_Length of each line_______ ©--- _"-""_ --.Width of trench.-- -------------------------- ---------------Type of filter material"_1d c •Depth of filter material----1-b" ` ----------------Total length--------l ---------------------------- Seepage Pit: Distance to nearest wefl--- c__"""Distance from foundation --_--.Distance to nearest lot line-_-1________ -_ ®� Number of pits_..---/-------------Lining material__A?!p _I i -------.size: Diameter--- --�3--r--- ----Depth_ ---- ------------------------ A =�--•- "' -------------- Cesspool: Distance from nearest well________________Distance from foundation _-------------Lining material--.._-_---____.-___-_"__""- ; A ❑ Size: Diameter.. ----------------•- -- ----Depth---------------------- ----------Liquid Capacity-------------- 1 --- ---- ------ gals. W Privy: �Bi�t e from nearest well-------------------------- .Distance from nearest buildingp - Disfance to nearest o me - ------------------------------- r Remodeling and/or repairing (describe):___"_..---_""-------------------------------------- p -------------------•--------- ----------------- ---------------------r-- ---------- t' - ----------------------------------- - -------•-------- - ---------- - -�t-- • - �i �+ - -------------------------------------------- ------------------------ -- --- --- - I Hereby certify that'I have p`repar6d 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. (Signed)--------------- `------- -------------------------------------------- t ------ --------------------------------- ------------------------ Owner and/or Contractor) - - - (Title)--------------- --------- ...... .... ---- -------- ---- (Plat plan, showing sizetaf lot, location.of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_"--_-" "" �- -� 6 - -------------------------------•----------- DATE_ --------------- BUILDING REVIPERMIT ISSUE DATE---- ------------------ --------------------------------- ED a - n - DATE--- ------- A#erations and/or recammeridatiot7s:.____ � �� -- --- --------------- ---------------- ------------- -------- ----r---- s ------------- ----------- -�: = ' ------------ ._.._ " �.,: �r1.s __mac stn --•s�--.r ..- �.:., �- ,,.".__ ,� ---------------- ------------ ----------- ----- FINAL INSPECTION BY:-.-1 0 - F Date SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Ma:elton Ave. 300 West Oak Street 13.4 Sycamore Street 205 West 9th Street 71 Stockton,California Lodi,California Mantecar California i Tracy,California a F.P.co.