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FOR OFFICE USE: ------------- ---------------- --. APPLICATION FOR SANITATION PERMIT Permit No. .._.frT.. ... ------------ -�-- - --��- -II-- (Complete in Duplicate) .I__'=-`_ - -- --__---__- -_- 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 construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. - JOB ADDRESS AND L CATION . Q - t` T f 7 '/--Q--- -------------------------------------------------------------------------- Owner's Name------___ � � C.r_rc _.r_z=i a -- ------- ------------ - Phone Address -----_-----------------------�a '�`/� �FGc------------------------------------------------------------------------------- t-' Contractor's Name ``.... Phone.--•---•-•......--•---------------- ' I -, Installation will serve: Residence []i Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: Nu r of bedrooms --2-- Number of baths -_,f-- Lot size Water Supply: Public system ommunity system ❑ Private ❑ Depth to Water Table ------ - ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sand m ❑ Clay Loam ❑ Clay ❑ Adobe ardpan ❑ Previous Application Made: (If yes,date- ------- -------- ) No KT New Construction: Yes Ej No fl---Ftp/VA: Yes ❑ No F, r' TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic T Distance from nearest well_.-�_._-_Distance from foundation__.,/._____.Material._ �? `_, Y_!_C,- ---__----_-- No. of compartments_-_-a _-__.Size!_�__X_y_ - depth_' -------------Capacity__ �Vr.-------- Disposa ield: Distance from nearest well-_,r- -._._Distance from foundation___ ___je7.f_...Distance ton lot line__.S_--�--- Number of lines-------- ___-�_.._ __ -___Length of each 1ine__. _moi : _'._________._.Width of tr �_`_-________ Type of filter mate nai__�/ ,-_ E��_�epth of filter material----------------------- length_-_ J�� 3L_._c_ k_�fr� Seepage it: Distance to nearest well----- :_..-_Distanc from foundation,/.Q__�-___.Distance to nearest lot line_-_!-1.... Number of pits__,__---------- -_Lining material-k 0-cV--_.Size: Diameter_��-?."-/_.---_-Dept -_-_--- O Cesspool: Distance from nearest well ----------------tDistance from foundation--------------------Lining material---------..__.-_-_.____-___-.-----_. ❑ Size: Diameter--- -------------- ------------- Depth_--------------------------------_-------------Liquid Capacity---------------------------gals. Privy: Distance from nearest well-____.---_----------------------------_ _._ -_Distance from nearest building __._ -------.-_-----_--_-.--_____-_._ ❑ Distance to nearest lot line- ----------------------------- ---------_----------------_-------••-------•----------------------------------------------------- J/ Remodeling and/or repairing (describe):------------ --------------------------- -----------------------------------------•---•---------------------•- .......------------•--------•--------- ------------------------------------------------------------ ----------- ----------------------------------------------------------------------------------------------------------------- ---___ ---------------- ------------------------------------------------------- --------------------------------------------------------•---------------------- ---_------------•------•-•------------------------------ O V1 I hereby certify that I have prepared this application and that the work will be done.in accordance with San Joaquin County ordinances, State law and rules d regulations of the San Joaquin Local Health District. (Signed) - .._. ------ Cl.- �_ _ -._-____.-_--___-._-_.-_ .-Owner and/or Contractor ------- 1: --- Title /j-- - - (Plot plan, showing size`of ot" cation of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-_-_.__.__-_- ------ --- - ---------------------- ------ --------------------------------- DATE-----��-��----�'�-------- REVIEWEDBY----------------------------------------- -- --- ---------------------------------- DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED----------------------------------------------------------------------------------- ------------------ DATE-------------------------------------- ---------------------- Alterationsand/or recom en ----ati ns- -----------,------ --------------------------- --------------------------------------------------------------------------------------------------------- G�, t --------------------------- -------------------------------------------------------------------------------- ------------------------- ------------ -------------------------------- - .___-... __. !t-------------- -___--_-.-----___--___--_-_.____ ----'-_ -• __• -------- ��' � �' �G�- �._- a" f'- .v�G 7=h---�?^'-------�-- -- -------------------------------------------------- ------------------------------------ -------------------- --------- ------------------------- FINAL INSPECTION BY:..--- . T_c.e --- ---------- ------------ - 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.CO.