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47 FOR OFFICEUSE: r C --------- -- _ r=-,�;s,� APPLICATION FOR SANITATION PERMIT Permit No. _ .Q��.......... _-- -- --- -- --------------------- - (Complete in Duplicate) '� J Date Issued _1�_-�_��r ___.__.___________ ---- ___� - _________________ 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 LOCATION----- � '�� (r --------------------------------------------------•--------- C.��+j �� Owner's Name_______________ - -------- - __... Phone _ _ _xy7_.__ - Address-----------------••- - / .r ------ --- Contractor's Name----- ✓ i �r / r`. , ;•---- .e `j-- _ Phone..0Tv._g�.'e4gr � Installation will serve: Residence Z__Kpartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __/-_ Number of bedrooms ---/_ Number of baths _,/__ Lot size ._ Water Supply: Public system 2--16ommunity system ❑ Private ❑ Depth to Water Table _' ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date--------- ----------) No E700' New Construction: Yes ❑ No [ FHA/VA: Yes ❑ No [— TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) F,C 6/'�„� ----- Septic Ta Distance from nearest well_________________Distance from foundation---lQ_.______.Material__--.-_/P_______.__.__.. __._.._______. s EL- No. of compartments-.._ '�f-___.----Size__-oj'_ ��f ------Liquid depth__.P' �_`�__.-__Capacity.��-------- Disposa Field: Distance from nearest well--.—'—..-----Distance from foundation...Z ._._.Distance to nearest lot line.... __-__Length of each line_____ Number of lines_______�..____ .._..____ g '�Q,__ ._____.Width of trench__�_ _____________ Type of filter mate rial_��,i�----Depth of filter material---� _.__--------Total length_-_____�______________----------- i See pag rr: Distance to nearest well----- -- __i_. ______Distance :{r� foundation_1_D__ . _____..Distance to nearest lot line__ ____ Number of pits-------f------- -- Lning material- f .Size: Diameter-- 2` - ----Depth------��`�---------------- 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---------- ----- --------------------------------------------------------•- ------------------------------- ,o Remodeling and/or repairing (describe):..__.._ �7 &�_-_____EX_J$-,7/1 �_______________ _S' ------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- I hereby certify that I have prepared this application and that a wo will be done in accordance with San Joaquin County ordinances, State laws, and rules and re ions of the San Jo n Local Health District. (Signed)------------ .� . �.� y------ - ---��------.- •• - ._.r__ wner d/or Contractor) BY: ------- ------ - -- -- ---- ---- ------------------------------------------(Title) ry . --t -------- . . .. --- -------- (Plot plan, showing size of lot, location system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY IF APPLICATION ACCEPTED BY------------ ---- ------- ----- ------------------------ ---------------------- DATE-------4 w ----- - REVIEWEDBY--------------------------------- ----------------------------------------------------------------•------------------------ DATE------------------------------------ BUILDING PERMIT ISSUED-------------------------------------------------------------- ------ DATE--------------------------------------------------------- Alt r tions a d/or recommendations:.-_-_..____--_--__.___-_-._-__.___ ., , i�. -� --- --- ---- AV FINAL INSPECTION BY:-----------��._r--------------------------- ------ 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.