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FOR OFFICE USE: f`c`- - ----------- ----lam?rad - . .. __ ____. ___________Y'_ APPLICATION FOR SANITATION PERMIT Permit No. _ 3 `r' (Complete in Duplicate) ----------------- '1--- --------------_______._. This Permit Expires 1 Year From Date Issued Date Issued -_-�--------- Application is hereby made to the San Joaquin Local Health District for a permit to constr ct and install the work hereindescribed.described. �1' This application is made in compliance with County Ordinance No. 549. 10wse !�^.s ltwd� oil JOB ADDRESS AND LOCATION___ __________J_� U a_ eW J1 - Owner's Name----- 9-------•- ..4---- - Q�-, .. - Phone------------------------------------ Address G °Z' IF--------- - 1 St-Q-- Contractor's Name ---------��0- V-------------- ----------------- -------------------------------------------- Phone----------------------------------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __I-___ Number of bedrooms __ Number of baths I------ Lot size -----/10- ----------------------- Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table .V ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sa Loam ❑ Clay Loam ❑ Clay ❑ Adobe a-pardpan ❑ Previous Application Made: (If yes,date--------------- No Rr New Construction: Yes [,]'No ❑ FHA/VA: Yes ❑ No [E� TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) � t nn Septic Tank: Distance from nearest well--=•'�--- -Distance from foundation---/&_�____.Material___ VNo. of compartments-.--------�_-__--.Size___ __—K,._..Liquid depth------ Capacity---AF6_�C>----_- Dispos Field: Distance from nearest well-__ .._ Distance from foundation.. ._d__l . Distance to nearest lot line. Number of lines-_----—;t _.. Length of each line____'r,!'�p��F_'�sa�_-Width of trench.--'- -------- '9 _.____.. _.._ p� Type of filter material_____ __/� __.Jam0g th of filter material------ �_'.�(__-__Total length------- .e..Q_� ________ � Seepage Pit: Distance to nearest well ,.t12_._._.---Distance om foundation____________ ____Distance to nearest lot line_. Number of pits------ .__-__-� g __Linin material__1 _�f____size: Diameter__,3,3._L--------DepthCP4=_____,,�_ Ni 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) * ,� (•G .. --------------------------------------------- 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 nd rules and regulations of the San Joaquin Local Health District. (Signed) / --------------------------------------------------------------(Owner and/or Contractor) By------------------- - ----- ------------------------------------------------------ _ - - - ------------(Title)--- - -- --- --- - - ------------ (Plot plan, showin . e of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY le Of APPLICATION ACCEPTED BY - ------- DATE D ----------------- REVIEWEDBY-------- ----------------------------------------------- -------------------------------------- ---------------•-- DATE------- BUILDING PERMIT ISSUED--------- -------- ---------- ----- - --- DATE------- - - - -- -- ----- ---------- Alterations and/or and/or recommendations:.-__- . 1<� _��- � ------ ----------------- _ �- y � --- -------------- -- ----------------------------------------------- ----- ------------- ---------- --------------------------------------------------------------------------------------------------------------------------------••-- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ --------------------- ------------- -------------------- ---------------------..........--------------------------------------------------- ------- ---•---------------------- ----- ------------------- ------ ---------------------------------------------------------------------------------------------------------------------------------- ------------------------- --------------------------------- ----------------------------- FINAL INSPECTION BY:.. '- -------- --- ----------- Date---------- ---------- ......0 ..f 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.