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FGR OFFICE USE: +� 01 1 e. .. j . oy 5I APPS KATION FOR SANITATION PERMIT Permit Iro. ................... .... . .................._1..:----- ------- ........441-V ------�- (Complete•in•Dupliaa4e) Date Issued �" This'Pdrmit Ex ices 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 co`pliance with County Ordinance No. 549. _� _ ,�" - yy JOB ADDRESS AND LOCATIC3�d_&./n-g7 4 --------1A`------1 --------------�" .� � '�� x Owner's Name-------"I� e__1- / I -- ---------------------------:- ----- Phone.f��.��_- -------------- Address .a. 1 ._. ---------- ------------------------------------------------------------------------ Contractor's Name------ "------- ----------------------------------- ------- ----------------------------------------------- Phone------ ---------------------------- Installation will serve: Residence), Apartment House ❑ -Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units:)_I_._._ Number of bedrooms`3__ Number of baths„ _ Lot size _ ....... I Wafer Supply: Public system:❑ Community,system ❑� Private Depth,to Water Table_49 ft Character of soil to a depth of 3 feet- SandA Gravel ❑ Sandy Loam ❑ Y(fiay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: l.If yes,date................... ) No JK New.Construction: Yes E) No E] 'FHA/VA: Yes El No 1E:11TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted ifpublic sewer is available within 200 feet.) Septic Tank: Distance from nearest well__,5.7.......Distance from foundation__./O----------Mat rial ___ No. of comit artments____ _ _ Y_,Sg-e, ----------Liquid de th__. Capacity /_ ____ Disposal Field: Distance from neares��'le ._.''Bistance from founds ' n__ Distance to nearest lot ane___, _______ .[� Number of lines_______ ____Length of each lin 0i of trench.._._ _ _...__ J� f----- ------- Type of filter materi .._.Depth of filter material.../f/......... length....... _____________________ i� Seepage Pit: Distance to nearest well______-----------------Distance from foundation_______________..-. Distance to nearest lot line__._______.______ Number of pits--- ------------------Lining material----_----------------. Size: Diameter-----------------------Depth--------------------------------- Cesspool: Distance from clearest well _______.______Distance from foundation................. ..Lining material--------_ _-----._..____.___-----____ Size: Diameter- _- .-_--_- ---a Depth--____________ Liquid Capacity ___________gals. Privy: Distance from nearest well________________________________________________Distance from nearest building___---.--..________.____________-..___.._. ❑ Distance to nearest lot lire — ✓ `-r7 - ---------- ----,-Q -------��--- ---------"s-� Remodeling and/or repairing k(describe):____. _ '_ - - ----------------- ----------- OL ____ ___ --- _____ ---------------------------------------5-------------------------------------------------'"--'----------..._-_----_---------._....-------..---" --------------------------------------------------------- -----______-____-_-___________._-_-____________...___________.________________________._.______._.____________.______.._.__.._____.___..___-- _____._._ _ I hereby certify that I have prepared this application and +hat the work will be done in accordance with San Joaquin County ordinances, State laws, 'and ruffles and regulations of the San Joaquin Local Health District. (Signed)----------------------------- ------ if (Owner and/or Contractor) -----------------Title (Plot plaf,, showing size of lot,'location eft sys+em in relation to wells, buildings, etc., can be placed on reverse side). l FO DEPARTMENT USE ONLY �i- I APPLICATION ACCEPTED BY. ------------ - DATE----- REVIEWED BY------------- -----------�� ------------------------------------------ --- ------ DATE------------------------ - Alterations and/or reco --- -- ----------------------------------- - ----------------------------------------------- DATE--------------- _. BUILDING PERMIT IU ----- -- / mmendations:.-(,9--.�.,F-_- C.. -------------- --------------------------------------------- -- --- - _T -- -I -- �-- ---------- --------4�r_�------ ------ � ----W------ -------- -• - FINAL INSPECTION BY. `ems.--- ------------ - ----------- Date------- .. .. ----------- ------------- SAN JOAQUIN LOCAL HEALTH DISTRICT j 1601 E.Hatelton Ave. 300 West Oak Street 724 Sycamore Street 205 West 91h Street �y Stockton,California Lodi, California Manteca,California Tracy, California ` E.H.9 2M 1-67 Vanguard Press