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FOR OFFICE USE: __________________- _ APPLICATION FOR SANITATION PERMIT Permit No. : ---------- (Complete(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 Ordinance No. 549. JOB ADDRESS AND LOCATIOON-----------T_"l---------1q,------- FITC ----------------------- --------------------------------------------------------- Owner's Name-----�.2--'----• WL.0,-r�')---------------------------------------------------------------------------- Phone.................................... Address---------------4--.,-v........1 N.* as------------------------------------------------------------------•------------------------------------------------------------_------- Contractor's Name--------� V_ j- ------ «. - v--------IS --------_-------------------------------- Phone-------------------------------------- ^� Installation will serve: Residence '� Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ---I---- Number of bedrooms ---I--- Number of baths ---I---- Lot size ........1-_'-_-_-X-_-(--E?_Q•---------------------- Water Supply: Public system /9 Community system ❑ Private E] Depth to Water Table -------- ft. Character of soil to a depth of3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 14 Hardpan ❑ Previous Application Made: (If yes,date--------------------) No �( New Construction: Yes ❑ No Nr FHA/VA: Yes ❑ Nox 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------------.---------.-:---___-_--_----_-__----- ❑ No. of compartments---------- ---------------Size-------------------------------Liquid depth---------- ----------Capacity------------------ Disposal Fi d: Distance from nearest well-iNLON E_Distance from foundation.......I_a_'__...Distance to nearest lot line-----S__-_____. 'p Number of lines-----------I---------------------Length of each line-----------0i' ---.-.Width of trench---------.2.-, `�-- ---.- -- Type of filter mate ria l._c�_ �C__Depth of filter material______-/S `iTotal length________________________- �__�__.__ Seepage Pit: Distance to nearest well----------------.-----Distance from foundation--------------------Distance to nearest lot line-----.-.___-_--._ Cy ❑ Number of pits----------------------Lining material----------------------- Diameter------------ Depth-------------------------._____- Cesspool: Distance from nearest well-----------------Distance from foundation.--.- --------Dining material------------------------------------- El _.-_-__--_---..--..__- __-._____❑ Size: Diameter------------------------------------Depth--------------------- --------------- ------;------Liquid Capacity---------------------------gals. Privy: Distance from nearest well ------------------------------------------------Distance from. nearest building__ ------------------------------:--_-_._. v ❑ Distance to nearest lot line------------- --------------------------------------------------------------------------------------------------------------------------- Remodeling and/or repairing (describe):__---_-- Tom_-. Xi%S_1�-1._15'_.-___ss ----------------------------- - - ---------------- ----------------------- - rfdx�se✓-- `-mss.-at r --------- t -- 7 I hereby certly that I�pared this application and that the work wi I be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed)---------- -- ---------------- 74_-f_A�---- ------- ---------------------------------------------------------- _..-____-.-Owner and or Contractor)- " By:---------- ---- ---- ---------- ----------- -- -------------- --- -------------------------------------(Title)------------------------------------------ .... ---- -------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY. ��Z--` �._.__3_-__. ------------/I= --- ------------------------------------ DATE- REVIEWEDBY-------------------------------------------- ------- ------------ -- ----------------------------------------- DATE------------- ----------------------------------------- BUILDINGPERMIT ISSUED--------------------------------------------------------------------- ------ DATE------------------------------------------------------------- Alterationsand/or recommendations----------------------------------------------------------------------------------- -------------------------------- ------------------------------------- --------------I------------------------ -------------------------------- --------------------------------------------------------------------------------------------------------------- ---------------------- ---------------------------------------------------------------------------------------------------------------------- ---------------------- ------------------ --- --------------------------------------------- --------------------------------------------------------------------------------------------------- - --- ---------------------5�'`--=... - ,---------------------------------------------------------------------------- ---------•------ -.-------------- FINALINSPECTION 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.0 C.