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' FOR OFFICE USE: r 2 45 7 .3 - APPLICATION FOR SANITATION PERMIT Permit No. ._�� _a ------------------------------------------------------- _ ______________________ - (Complete in Duplicate) � _�__�__ ______ __ ___ 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. OCATION.!C rt -=t .rfi71=�T`D�Z!� .✓ _. vk_trr. __s _.�' :'� Owner's Name... C�� `1__�`'.��?' �'1 L f = �zr_, '!1r%7- L =c' <tw ! Phone--------------------•----= l� Address-................... �T -=. .._.�.. 1 �`�x--•---. ----•------------ --------------1-----------------------------------------------•------------------------•-------- Contractor's Name------'_�: � _ �e '_l _1 ------- fY --------------------------------------•--- __-__ Phone.'r1eG�, T Installation will serve: Residence &-Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ I Number of living units: ___f_ Number of bedrooms _3--_ Number of baths/�' Lot size ..........o,,—V �'fr'_ "____-___________ Water Supply: Public system ❑ Community system ❑ Private E"epth to Water Table ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam 0--�Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date---------- ) No New Construction: Yes E] No FHA/VA: Yes [-] No Ej� TYPE OF INSTALLATION AND SPECIFICATI4S: (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--------- t Size...........................•=--.Liquid depth--------------------------Capacity...................... Disposal Field: Distance from nearest well_________________Distance from foundation_________-_________-Distance to nearest lot line................. ❑ Number of lines___________________________________Length of each line-------•----------------------Width of french__________.__,________.__-_________ Type of filter material-------------------------Depth of filter material_________._____________Total length.......................................... Seepage t: Distance to nearest well__jS___r_________Distance fr m foundatiorJ�__ ........Distance to nearest lot line_/�'____.._._ � Number of pits------1____-_______Lining material_z5 :?G�(�_.Size: Diameter_ ,-. r-__---__Depth- _________________ Cesspool: Distance from nearest well_________________Distance from foundation----.---------------Lining material_________-_______________________-___. ❑ Size: Diameter--------------------------------------Depth---------------------------------------------------Liquid Capacity---------------------------gals. Privy: Distance frorrrl r+d%Akt weDistance m nearest building------------------------------------------ ------------ - _,., _ ❑ Distance to nearest lot t1 -------------- ------------ --- --A ----- Remodelin and/or repairing describe :__-___ _ :� ___ l' ______________________ -------------------••--------------------------- ---------- --------------- �" - -------------- - t�X,-?4,j _c�U /=. / - ' `r t - - -------- �, - ------ --=------------------ - -- -- --------------------------------------------------------------------------------------------------------------------------------------------•---_-•------------------------------. I hereby certify that I have prepared this application and that the work'wilt`be"dila in"accordance with San Joaquin County ordinances, State laws, and rules and fegulation; of the San Joaquin Local Health District. --� /t! C-- __ ne "and/or Contractor (Signed)---------- -----/ ,�✓ !'�,�, --------------------------- / ) -3 By:------- Title)-- - ---_ -tea ( - � (Plot plan, showing size of lot, (ocati6n cf system in relation to wells, buildings, etc., can be platted on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY DATE---� -' ,-----" REVIEWEDBY------------ ---------------------------------------------------------------------------------------------------------- DATE .----•------------------------------ BUILDINGPERMIT IS, UED----------------------------------------------------------------------------------------------------_ DATE...................-Y----------------------------............ Alterations and/or ret'ommendations-----------------------------_----------------------------------------------------= -------------------•-• -------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------=----------------------- --------------------------------- ----------------------------------------------------------------------------------------------------------------- ----------------------------------------------------- ------------------------------ ---------------------------------------------------------------------------------•----------------------------------•------------------- -------------- ------------------------------------------------------ ---------- ----------------- -------------------------------- ------------------------------------------ ------------------------------ FINAL INSPECTION BY:./--;4?- %-- Date_F-d_- 2''^�3 -- - - --------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haselton Ave. 300 West Oak Street 124 Sycamore Street 20S West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.CO.