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FOR OFFICE USE. _____________________________ _ . APPLICATION FOR SANITATION PERMIT Permit No. ...1 a..r✓_. ---------------------------- ------- --- (Complete in Duplicate) Date Issued ----- ------------ ---------------- _____-------------__------- 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 Ordin nce No. 549. „ JOB ADDRESS AND LOCATION.---' -1---- --y_.___._- ----px___.„ -?�---------/._/ d__J✓D�4'l Owner's Name----------------- �_ A �yq�N� _._... ----------------- ---------------- ----------------------- ------------------ Phone.' : _ILS ._. Address----_--------------------1 7- . .......OP-k---- �' _------------------------------------------------------------------------------------ ------------------------------------ Contractor's Name-------- ,�t/ �+ __... -•-�� =S-I�--J---� • --�------------------------------------------------------------------ Phone-=f•--•--•----� .. -� Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _1.__ Number of bedrooms _. Number of baths ___l___ Lot size _________�_ _ 4ex_5—_-__--_--_ Water Supply: Public system ❑ Community system ❑ Private g Depth to Water Table __4_Oft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam M Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date___________________) No [X New Construction: Yes ❑ No 2L FHA/VA: Yes ❑ No Ig 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---------.-----_-_.-_-___-_-_---_----_._-__-----. ❑ &xI ST1.47o. of compartments--------------------------Size-------------------------------Liquid depth------------------------.Capacity--•----•-------------- Disposal Field:_ Distance from nearest well_________________Distance from foundation � foundation-_---__--_.--___-_-.Distance to nearest lot line----------------- 14 Ale [9 of lines______________f __ ____________Length of each line_______ Width of trench--__—o -0 -___-_.---.-____-__ Type of filter material-__-�� '--Depth of filter material__A0'".---------Total• L' length__--___--� _�.___________________ s Seepage Pit: Distance to nearest well......... i___Distance fro foundation to nearest lot line--o& -- A45*^K Number of pits.__-____ _________-Lining material3 �lSize: Diameter---- Depth-- _______________________._ Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material------ -----------------------------O'Q ❑ 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):___ ---- --------- r / ' _..._ ,45x -------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------ ------ -------------------------------------------------------------------------------------------------------------------------------------------------------------- --------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------_------------------------------------------------------------------------------------------------------------- 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. r__77-7 (Signed) _ ___ _ ls (O er and/or Contractor) By:------------------ a ,.� !"te -----------------------------------------------------------(Title)---------4J- -t- ---- - -- --------- (Plot plan, showing size of lot, locatio of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE O LY APPLICATION ACCEPTED BY_ __-______--- ._ : ____i__-_�_---__-- DATE --------- ------3 --------------------------- REVIEWEDBY-------------------------- ---------- ------- ---------------------------------- ------------------------ DATE----------•---- ---------------------------------------- BUILDINGPERMIT ISSUED------------- ----------------------------------------------------------------------------------- DATE------------------------------------------------------------- Alterationsand/or recommendations------------------_-- ----------------------------------------------------•------------------------------------------------------------------------------ ------------------------------------------------------------ --------------.------------ --------------------------------------------------------------------------------------------------------------------------------- ---------- --------------------------- --------------- - ---------------------------------------------------------------- ----- --------------------------- -------------------------- -------------------------- -------------------------------------------------------------------- ---------1-------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------ ----- - - - %------ -------------------- ------------------- --------------- .---------------- --------__--------- ------- ------------------------------------------ FINAL INSPECTION BY:, - - '-`-'-- --- ------------------------------ 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.P.r.O.