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FOR OFFICE USE: r -------------- 1 s ` ----- APPLICATION APPLICATION FOR SANITATION PERMIT Permit No. . .z%. , 5' ? s� t ) (Complete in Duplicate)---- � -�- '- (Com P P ) Date Issued ------------- a -_, f - �� 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 Count Ordinance No. 549. JOB ADDRESS AND LOCATIOyyNI---._.T:2 --------- e Owner's Name---------- < J> , L----------------------------------------------------------------- Phone._3?3/__� - �f� Address..................... e -'------------------- . . -.fC 4� ----------------------- Contractor's Name-- 1_ .. 'tl/ -- ---- Phone.'^ _eo-_ Installation will serve: Residence [�Apartn,,r# House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __`.-_ Number of")' Brooms _.Z_ Number of baths -_�___ Lot size ._ _G/__.-,00P----------------------- Water Supply: Public system ❑ Community system ❑ Private--RI/Depth to Water Table 40-0--- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam [1-'1!!iay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date--------------------) No ❑ New Construction: Yes ❑',No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION ANI:) 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-------------------.-------------------._-_-_---. No. of compartments--------------------------Size---------------------- --------Liquid de th_-_._____--_-_-___-.._Capacity Disposal Field: Distance from nearest well,4P4V •._Distance from foundation.._ _...Distance to nearest lot line----P.". Number of lines_____________�.. .. _. _ -___Length of each line------- f--�--_. .Width of trench----- A `j_.._._________ Type of filter material__-S� .G/) --Depth of fiI44,material_/e�__. _-____._.Total length______ ______________--_-_-.-.. Seepage P Distance to nearest well__1,0a..........Distancefrgtn foundation___ ____________.Distance to nearest lot lis----�P.... Number of pits------/-------------Lining mate ria l_..�t' �Size: Diameter-a_�_,�-_-.------.----.Depth_ _---_-_._--_--._-__-!Q Cesspool: Distance from nearest well----------------- 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 -----Remodeling and/or repairing (describe):___ ._ -7__-_-_- �Y...__...Z/e........................ ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ --------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State I - , rules and regulations of the San Joaquin Local Health District. (Signed)--------------------- -- lam-oc -�------------------------------------------ - ner d/or Contractor) By:---------------- --- ---------------------------------------------------------------(Title)----- - f- - - (Plot plan, showing size of lot, location system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY........0!----- ---------- --- --- -------------- ------------------------------------------ DATE-------T- ��-- --- - REVIEWEDBY-------------------------------------------------- ---------------------------------------------------------------------- DATE_--------------------------------------------------------- BUILDING PERMIT ISSUED -----t-_---`---------------------�-..-- -- ----- !�- ----�--- ---------�PATE _..--------c-_---�--- -`-_----`,•-�----�---�------ -�-�-'--�----r------ ----------- -Y. Alterations and/or recorpm��tion ------- t.,�� - ----- --- • -•---------•-- --- ` -- ---------------- --------------- �i'fir. t�J L�c � ^ �r �.. zz D �?�J�_.;-„ FINAL INSPECTION BY:. ------ - -----�`-�--------------- Date_.. `�j � 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.CO.