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FOR OFFICE USE: ------------------------------- ------------------------ ,, APPLICATION FOR SANITATION PERMIT Permit No. ��Z. `s`�7 -------------- -------------------------------- (Complete in Duplicate) Date Issued 13__.4�A'7 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. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION-ii-----------CUX -------------f`�-=--------------------------------------------------------------------------------- Owner's Name---------------------q.6e 1 __ 6 - Phone_ _- ---------------------------- ._ Address--------------------------------------- �`-�G- =------------------------------------------------------------------------------------------------------------ Contractor's Name--------_------------------ ------------------------=--------- -=---------------------------------------------------- Phone----------------------------------- Installation will serve: Residence [Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ E]Other Number of living units: ---I--- Number of bedrooms ---/--- Number of baths _t-.-_ Lot size -----A I-----_-_---------------------- Water Supply: Public system ❑ Community system ❑ Private [[Depth to Water Table ./0- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sanay Loam ❑ Clay Loam Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date---------_-------._) No 0' New Construction: Yes ❑ No [ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: /%VO IAJ (No septic tank or cesspool permitted if ublic se er 'At s available within 200 feet.) Septic Tank: Distance from nearest well_�� Distance from foundation------/Q----------Material_--- ---__._-._---__-__. 21, No. of compartments----------- __ __ Size_-_-.Y=_� '1_471------- Liquid d ------_Capacity.... epth.-----.-_-- � .$�C�...... Disposal Field: Distance from nearest welly'.._.__---_Distance from foundation-----40---------Distance to nearest lot line...47----•--- Number of lines---------------A--------------_Length of each line----------Y0-------------Width of french-------cy"'------------------ ❑� Type of filter material____5Ar_.A�-__Depth of filter material--_-_l$_-.,---...Total length----------5u,-_---_--_-_-_----------- Seepage Pit: Distance to nearest well----------------------Distance from foundation____--_-_----_-.Distance to nearest lot line----------------- El 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):-------------------------------------------------------------------------------------------------------- ----------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- -------------Ug�sixe ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- I hify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinanla , and rules and regulations of the San Joaquin Local Health District. (Signed) ------- ----------------------------------------- ----------------------------------------------------------------.(Owner and/or Contractor) B ---------------------------------------------------------------------------------------------------(Title)-------- ------------- (Plot plasize lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR IKEPARTMENT USE ONLY APPLICATION ACCEPTED BY ----------------- ---- DATE =2- G7 REVIEWED BY----------------- --- ---- ----------- ---------------------------------------• ------------------------------------ DATE-------•------------------------------------ --------------- BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------ ----------------- DATE------------------------------------ Alterations and/or recommendations:------------------------------------------------------------------------------------------------------ -------------------------------- .-----.- -- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ ---------------------------- ----------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ ----------------•----------------- ----------------------------- -- FINAL INSPECTION -------- --- ---- ------1------ Date--- �� ----------- ----------------------------------- SA 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 d . , F.P.CC.