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FOR OFFICE USE: ------------------ ------------------------------------- ._-___.__.-____-_ , { _ - APPLICATION FOR SANITATION PERMIT Permit No. _�.7. l� -------------------�----- --y---- - -------------- (Complete in Duplicate) R. --------------- 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 describgd. This application is made in compliance yti#h f ount Ordj pg,e o. 549. JOB ADDRESS AND LOCATION._ ' G = f - '�1 = ✓'Y__<< _. ._. ;� - --------- Owner's Name-- i% .... '�d d Phone. Address ` - =` -. 'Lc.... ....................................--� "� ------------ Contractor's Name-- - - --------~ -----1�t_..G� �?_5---------------------- ...--------... Phong ._ . Installation will serve: esidence' Apartment House ❑ Commercial ❑ TraiE] Mote! ElOther ❑ Number of living units: .-/-- Number of bedrooms ---4' Number of baths __ __ t size __----C_e?.k...?'a2_- - ---------- Water Supply: Public system ❑ Community system ❑ Private X Depth to Water Table A.'Q�ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ AdobeMC Hardpan ❑ Previous Application Made: (If yes,date--------------------) No 2' New Construction: Yes, 'No ❑ FHA/VA: Yes ❑ No jar 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 f rn_ foundation___/_(1__------Material_-__�4��- -------------- .x No. of compartments__ ._ _ ._--_._____ _Size__ ._------- _ �.__.Liquid depth____..__.._.._______._Capacity_Ma_Q_G��. Disposal Field: Distance from nearest well__.......Distance from foundation...ee�Q......_.Distance to nearest lot line_....�a...... Number of lines------- __-' ___ .---.----Length of each line. l _P -- p'_.Width of trench-----a------------------------- Type of filter mate ria l__ ' ---------Depth of filter material__/°"—--------Total length----a--9@._'°................. �� Seepage Pit: Distance to nearest well__/_______ -----Distance from foundation_ZO----_.-------Distance to nearest lot Number of pits__._-.___.___--Lining material---os ---Size: Diameter_ .?`........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------------------------------------------- ElDistance to nearest lot line----------------------------------------- -----------•----•------------------------------------------------------------------------------- Remodelingand/or repairing (describe):-----------------------------------------------------------------------------------------------•------------------------------------------------------- --------------------------------•--------------------------- ------------------------------------------------------------------------------------------------------_--------------------••--•---------__.•- --------------------------------------•--------------------------------------------------------------------•------------------------------------------------------------------------------------------ - ------------------------------- -----------------------------------------------------------------••------------------------------------------------------- ------------------------------- t 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)__________________________________ ___ (Owner and/or Contractor) By:---------C.. f E _ )'- ---------------(Title)-------------------------------------------- ---- --------- (Plot plan, showing size of lot, location of sysfm in rela n to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ---------------------------------------------------------- DATE-------------- REVIEWEDBY----------------------------------------------------------------------------------------------------------------------------- DATE------------------------------------------------------------ BUILDING PERMIT ISSUED-----_---------- ------------------- ----- ---- DATE--------------------------------------- --------------------- "' Alterations and/or recommendations:------>, ------ ___.- �jG//G6. FINAL INSPECTION 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