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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. ----- ----- ---I---------- --- -------------------------- ---------- I I (Complete in Duplicate) 3' --- -------------- -------- ------- Date Issued ---- ............. ------------------------------- . I This Permit Expires I Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and inst&the work herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION--------------------------- 1-3�49A------------ ............... 7- 1 1---- -.;I------------ Owner's Name---------------- ------/_Z-0---------- ---------------------------------- -------------------------------------- Phone. 4!_fR�F Address----- -------®X- ------ ................. Contractor's Name------ ----- --------------------------------------- Phone. Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court E] Motel E] Other F] Number of living units: J--- Number of bedrooms ___2 Number of baths Lot size, ------- ------------- Water Supply: Public system F] Community system Ej Private K Depth to Water Table _46_ ft. Character of soil to a depth of 3 feet: Sand E] Gravel [] Sandy Loam ❑ C16y Loam F] Clay 2' Adobe[] Hardpan 0 Previous Application Made: (if yes,date--------------------) No 14, New Construction: Yes E] No FHA/VA: Yes E] No�r TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) -------------------I--------------------------- Septic Tank: Distance from nearest well------- -- ---Distance from foundation__._.___.___.:.._ .Mate ial-- ❑ No. of compartments--.--.._.------- --_-r=Size--------------------------------Liquid depth--------------------------Capacity--.-------------. ----- Disposal apacity----------------------- Disposal Field: Distance from nearest well_--".-'Distance from foundation----e�x---------.Distance to nearest lot line.-* 7�------ --- 110 -- -------- Number of lines___________ -----------Length of each line-----X-'67-� Width of trench__sP2,1111;Z------------------- Type of filter material---- Depth of filter material---//�---------Total length-------�------------------- Seepage Pit: Distance to nearest well-AM---/-----Distance fropn foundation----a.7S--------Distance to nearest lot line-- 51'e'Arste Size: Diameter---- ------------------ Number of pits---_/_----------Lining material--- -- --- -------Depth------- Cesspool: Distance from nearest well-----------------Distance from foundation-------------------Lining material...._._---.-._,--_-__.-----_____--. � . ❑ aterial..... ------------------------------ 171 Size: Diameter-----------------------------------.Depth------ ---------------------------------------------Liquid Capacity---------------------- -----gals. Privy: Distance from nearest well. -------------------------------------Distance from nearest building-------._--_-._--__--_.--_-__-----_--.-.-. (� ❑ uilding------------- ---------------------------- 1-71 Distance to nearest lot line----------------------- line----_---------------------- ------4-5-�-----V-------------------- ---I--V-_-_----<---7---------- -------------------------------------------- Remodeling and/or repairing (describe):- -, / --- . --- / -�----I------A..... -----•-----------------------•--------•----------•--- ------------------ ----------------------------------------------------------------------------------- ------- ------------------------------------------------------- ------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- I hereby certify that I kave-prepared this applidbfion and that the work will be done in accordance with San Joaquin County ordinances, Stated les and regulations of the San Joaquin Local Health District. � (Signed)--------------------- �_e—---------------------------------------------------------------Qwner;And/or Contractor) - , - ��_x " , "el ------------------------------------------------------------(rifle)------ —.-_4................ By:-------------- (Plot plan, showing size of lot, location f system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------A ----------- ---------------------- DATE-------/.-?"f/_Z7 ------------ ---------- REVIEWED -- -- ---------- REVIEWED BY------------------------------------ -- ---- ......... - ----------- DATE BUILDING ------------------------------- --------------------------- PERMITISSUED------------------------------------------------------------------------------ ------ ---------- DATE------------------------------------------------------------- Alterationsand/or recommendations:------------------------- ------------------------------------------------------------------------------------------------------------------ ----------------- --------------------------------------- ------------------------------I------ ---------------------I-------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------- -------------------------------------------------------------------------------------- --------------------------------- ----------------------- ------ -. --------------------------- ----------- ----------------------------- ------------------------- ------------------------------------------------- ---------------------------- -- ----- ------------------- -------------------------------------------------------------------------------- ------- -------I...... -------- ---------------------- ------ FINAL INSPECTION BY:----- 4v......... ------------ Date---------- G------ --------- ------- 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.120.