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FOR OFFICE USE: ------------------------------ -"--------- ------ " APPLICATION FOR SANITATION PERMIT Permit No. __ / .5 2 ----- ---------------------------- 1� ----------------- ------- --------------------------- -- " (Complete in Duplicate) 7 bate issued --------------------_----_------------------.--------.-__ This Permit Expires I Year From Date Issued ,e r Application is hereby made to the San Joaquin Local Health District for a permit to construct'and�install the work hereinx,0escribed. This application is made in compliance with County Ordinance No. 549. 0 JOB ADDRESS AND LOCATION ��-`---�`------�- -�-------�� `7�vt- -------�-------------�-v a-- a -- f r - v' ' ��' ---------- /� Owner's Name------Ll.--a--- ------`��"t ` ��L---------------------------------------------= - ---------- ---------- ------------- --------•---- ------ Phone--- ----------------•----------•---- Address__, --1-------B°x------------7. --- ✓1 ti_ 7 :e 4'=------. � Contractor's Name__Dg_1S.__ r_ __. - c� f z 7 -------M_eof c c-- --`---- -- Phone_ ff_ _-_rQJS.f Installation will serve: Residence 0" Apartment House E] Commercial El Trailer Court El Motel ❑ Other ❑ Number of living units: _/_____ Number of bedrooms _ -._ Number of baths __is____ Lot size _____ 'f______________________________________ Water Supply: Public system ❑ Community system ❑ Private F- Depth to Water Table _tea_ ft. Character of soil to a depth of 3 feet: Sand R'Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan Previous Application Made: (If yes,date -------------------) No P. New Construction: Yes ❑ 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 wel1___3 __/_..._Distance from foundation---/._!a__r------- rr r [ No. of compartments------ ----------------Size__sy_-x- -zf_`f.---Liquid depth------`7`_-_-.----------Capacity-_lz r. --. Disposal Field: Distance from nearest well----$..........Distance from foundation__/°-------------Distance to nearest lot line__tE----------- + ©' Number of fines________�_______._________.._Length of each line-----6:�------------------_Width of french.._.2--__ ____ --------------------- Type of filter material----Ak�;A_..----Depth of filter material---.LX- ----------Total length___. ____________________ Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line_____.___..___-__ ❑ Number of pits----------------------Lining material--------------.--------Size: Diameter------------------.----Depth_ __.-------------------------- 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):--.-_'-Y_c,U_'5__F_-----Z..'x - ------ ----.---- -'5-- i---�a- -3: _s.7~�.e --------!'S-------—F-Cl' '�A— -----------------------------�------ �----- --------- --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- -------------- - ---- ------------------------------------------- -------------------------------- I 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. (Signed)----:x9;_,,�------,!', t� ----------------------------------- --- ----(Owner and/or Contractor N By:---------- --------------------------------•------------------ --`------- _------- ----- ---------- ---------------,-.-,-r----- T _ ---[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--- } - --=----------------- --------- ---------------------------------------- DATE------ '- 7: �' �--------------- REVIEWEDBY------------------ -------------------- ---- --------------------------------- ---------------------------------- ------ - DATE----------------- ------------------------------------------�\(J BUILDINGPERMIT ISSUED------------- ---------------------------------------------------------------------------------------- DATE------------------------------------------------- ----------" !1 Alterationsand/or recommendations-------- ------ ------------ ---------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------ ------------------------------- - -------------------------------------------- --- --------------------- -------------------------------------- -•------------------- a ---------- -- ------------------•--------- ---------------------------------------------- ----------- ------------------ ---------------------------------- ------------------------------------- -------- -------- --- -------- - - --- - ------------- 1 - - _ r------------------------- FINAL INSPECTION Date--------------- --`-_. _`. .._ SAN JOAQUIN LOCAL HEALTH DISTRICT t 1601 E.Haselton Ave. 300 West Oak Street 124 Sycamore street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.G•p. 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