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FO OFFICE USE:----------------- ------ _ r"a-r6.... APPLICATION FOR SANITATION PERMIT Permit No. ---------------I--- ---------------------- (Complete in Duplicate) --------- ------------------------------------ This Permit Expires 1 Year From Date Issued Date Issued _____/. 5�1---� 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 Ordinances No. 549. JOB ADDRESS AND LOCATION-----------` 1t'rCf�,�`Tf� l Owner's Name - F A_?_/Z/_, _t S- -----------//Zq - -r J-0--------- ----------- ---------- Address----------------------- Contractor's Name------------ �' � 1 - �*r Phone Installation will serve: 1 Residence ©'Apartment House E] Commercial ❑ Trailer Court ❑ Motel ElOther ❑ Number of living units: ___l__ Number of bedrooms __`Number of baths __l._ Lot size ----- _ _----, ""-_`------------- Water Supply: Public'system ©f ommunity system ❑ Private ❑_ Depth to Water Table 4!'_ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam L] 'Clay Loam D—Clay ❑ Adobe.❑ Hardpan ❑ Previous Application Made: llf yes,date__..__.............J No [ 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 well_________________Distance from foundation-------------------Material------------------------------------------------- El ________..__________--_._.____-__.._- _-___.❑ No. of compartments - -Size-----------------------=--------Liquid depth--------------_- ------._Capacity-----I----------------- Disposal Field: 'Distance from nearest welt_________________Distance from foundation--------------------Distance to nearest lot line___.___________-.� ❑ Number of lines------------------------------ ----Length of each line--------------------..._------Width of trench----------------------------------_ Type of filter material___ ___________________Depth of filter materia(_-_-.___._____._____..Total length_____-__.._______- _- -____ Seepage Pit: Distance to nearest well__________ ________Distance fro foundation___ --(___.Distance to nearest lot line__`._~"__. 1150 ._ ❑ p / .-._.__Lining material Diameter----- - -.`Y----.Depth--.- -, __�-------------- �- �� Number of its--.___-- _- -- # �8 Cesspool: w Distance from nearest well_________________Distance from foundation_____.-------.------Lining material---------------------- ________-___. ❑ Size: DiameterN. - Depth -- ---------------------Liquid Capacity- -------------------------gals. Privy:❑ Distance from nearest well--------------____---------------_---------------Distance from nearest building------- ---__.._____________._ ---------- - Distance fo nearest lot line Remodeling and,,o ' in9/(des-cribe]:____-- Z "iG --- �--- 1 ----•------------------ L ---------------------------------------------- - �`-`- 3 -------- - --------------------------- --------------------------- } --------------------------------------------------------------------------------------------------------------------------------------- ---•----------------------------------=---------------------------------------------------------------------------------------------------------------------------------------------------- ------ I hereby certify that I have prepared this application and that the,work will be done in accordance with San Joaquin County ordinances, State law , and-rules and regulations of the San Joaquin Local Health District. (Signed)--------------- ---------- n d/or Contract By �i�[d'� uP�C.....----`---- - or] Y� ''"� � --------- -----(rifle)----- Wit. R ------- (Plot plan, showing size of lot, location of s sfem in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY 1 APPLICATION ACCEPTED BY--- —-- -- -------- ------ ------------------------------- DATE--------- � i REVIEWEDBY ----- ------------------------- - ------------------------------------------------------ DATE ----------------------------------- BUILDING PERMIT ISSUE ------ D — DATE Alterations and/or recommendations------ _ --- -------------------------------------------- ------------------------- ----------------------------------------------------------------•--------------------------------------- ----------------------------------- FINAL INSPECTION BY:. __ -----` - t5 1 ��`�- 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.RQU,