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L�FOR OFFICE USE: �r !/ ------ ------------1-t- ii j ----------------------- APPLICATIOO FOR SANITATION PERMIT Permit No. _.f _1.... Com lete in Du tJ----------------- ( Duplicate)P� ) Date Issued ...6 ______________ 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-_--------------- t1 ` / --------------------------- - ��77----- ------------------ Owner's Name ISM I-5 tv _5- ------ Phone...417----<iVC-9 Address. - ---------------------------------------------- `----------------------------------•----------- -------------------------- Contractor's Name---------------------------------------------- 5 ....... -------------------------------------- Phone--T/- o---X607---- Installation will serve: Residence 54 Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _.1----- Number of bedrooms ___ZNumber of baths .-.I... Lot size ------ -------- -------------------------------- Water Supply: Public system ❑ Community system ❑ Private Ig Depth to Water Table ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam X Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date--------------------) NoNew Construction: Yes ❑ No FHA/VA: Yes ❑ Noj4_ 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 Field: Distance from nearest well._,.6—d__1---Distance from foundation.-,/.,.(-.__...Distance to nearest lot line-30-- Number of lines---------------- ._______-Length of each line...---------TO_�___._-...Width of french..._.�-�.'!...______._....- Type of filter mate ria l__�_ LC_--Depth of filter material---/--*-------------Total length--------9,14.1........................ Seepage Pit: Distance to nearest well ...___Distance from foundation....................Distance to nearest lot line----------------- 171 Number of pits______________________Lining material-----------------------Size: Diameter-----------.-----------Dept h-----------.-------------.._...._ W Cesspool: Distance from nearest well.................Distance from foundation----.---------------Lining material------..____._.._._.._....---.-----_. ❑ Size: Diameter-------------------------- ----------Depth----------------------------- ----------------Liquid Capacity----------------------------gals. S Privy: Distance from nearest well--------------_._.-----------------------------Distance from nearest building--------------------------._.__.....____.. ❑ Distance to nearest lot line------------------- - ---------------------------------------------------------------------------------•----------•--•------------------- - Remodeling and/or repairing (describe):------ --14ep-I_'Ld0---------__-t.-U-------------7k_. .5._r4 ---._.-------. y-S--•------_--- -_-... ------------•--------------•---•------•------------------------------------------------------------------------------------------------------------ -------------------- --------------------••------------------------- ----------•---------------------------------------------------------------•------------•---------------•-----•--------------------------------------•-------- -------------------•------------------------- --------------------------------------- --------------------------------------------------------------•----------------------------------------------------------------------------------------- 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, and rules and regulations of the San Joaquin Local Health District. (Signed)------------------------------------------ —?_r &P--I, 6-�------------ C--" ( caner and/or Contractor] �y By:--------------------------------------------------1-` :. -- ------- - ----------- ----------------------(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-- - DATE----L=- - ----------------------------- REVIEWEDBY--------------------------------- ---------------- ------------------------------- --------------------------- ..... DATE-------------------------------------------------........... BUILDINGPERMIT ISSUED------------------------------------------------------------------------- --------------------------- DATE------------------------------------------------------------- Alterationsand/or recommendations---------------------- -------------------------------•-----------------------------_------------------------------------------------------------------- --------------------------------------------------- ------------------------ ----------------------------- -------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------- ------------ ------ --------------4------- -------------- -------------------------------------------------------------------------------- ----------------------------------------------------------------- ------. ------------------------------------------- ---------- ------------------------------------------------- -------------------------------------------------------------------------------------------------------------- 41 FINAL INSPECTION BY:----_.._C:-: - -----------------------------------6 ' � �� ------------------------------- --------•----- 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.CC.