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FOR OFFICE USE: ------------------------------------------ -------------- -------------------------- _s 1_ _ _ _ - _ ------ APPLICATION FOR SANITATION PERMIT Permit No. __r ��= .._..... ------------ -------- (Complete in Duplicate) o� e' _-___._---____________-__...______-__-.__ This 'Permit Expires 1 Year From Date Issued Date Issued ______-__)_'__:e 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 wish County Ordinance No. 549. E JOB ADDRESS AND LOCATION/ ^',( / 0- 1 _1�lC_.._!_ r_;� �Y�A' �_Se;-tet F _Sc?.< �:• __' _-- Owner's Name---------77_4r. ---------._C �_S_ X,_7-- ti`------------- ------ - ------------------- Phone--------------------•--------------- Address---------------------- t>.ts_ /o-q, r ------------------ --------------------------------------------------------- --------------------------- Contractor's Name - - -4o4:'-------------------------------- ------ Phone_. .4r.J_0_c2 .------- 11 6 Installation will serve: Residence [P-'Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ...f_ Number of bedrooms _,' Number of baths J___ Lot size ---------------------- Water Supply: Public system ❑ Community system ❑ Private [Depth to Water Table �P_ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel �ancly Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date_____ -------) No ©-� New Construction: Yes B' No ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic +ank or cesspool permitted if public sewer is available within 200 feet.) ---� Septic Tank: Distance from nearest well i0'1—Distance from foundation /O._- - -Material_ lRe `j_,s-------------------- No. ___- -. _---_.No. of compartments___ -------------Size- _Ls_ --Liquid depth __6 -f �r _._ Capacity jdewO / Disposal Fie4d: Distance from nearest well__- ',o------Distance from foundation__149----------Distance to nearest lot line_.rIQ'__, r Number of lines---------- ____-__ ____Length of each line.-%� -'' ' '��.Width of trench_, !y.---__--_______________ Type of filter material__slle°�K_ Depth of filter material_/f'''___ -_Total length___rr'--�1_--`_________________----_ Seepag,6 Pit: Distance to nearest well__--- _-___________Distance from foundation--------------------Distance to nearest lot line--------------__ ❑� Number of pits-------.__ _____ __Lining material------ --- ____.--_-.Size: Diameter_____________ -__-Dept h-------------------------------_ 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 _____ _______--------- ------Distance to nearest lot line - --- -- ---------------------------------- - _-------------------------------------- ------------- - 4. Remodeli g or repairing (describe):- -----� ,.x-77 ----------- •�'G'�t "� �'G' S ----------- 4t_T i ---------- - --------------- - ------------------------------------------------- --- -- - -- pKa ---------- ------------------------------------ ---------- ------------------------------------ ------------------------------------------------------------•------------------------------------------------------- ------------------------------------ --------------- ------------------------------------------------------------------------- -------------------- ----------------------------- ----------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County A ordinances, Stat�and rules and regulation;.of �enoaquin Local Health District.r,,(Signed) -!el'sll------- ----- -........... - - ...................... - - ---------- By: - (O r d/or Contractor) By:--------- ------- `�---- -------------------- -------------------------------------(Title) ------<--------- ------ ---------- -- _ ..-------- (Plot plan, showing size of lot, Iota ' n of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----------------------------------- -------------------------------------------------------- DATE----------i------------- --------------- ----------------- REVIEWED BY_------------------------------------------ -- --- -------------------------------, - DATE '=- � -" ----- BUILDING PERMIT ISSUED___ __ _. -.' "---f- _/OATE_ _ ____Alterations and/or recommendations--------------- ----------- ------------------ ----------------------------- -------------------------- ----------------------------------- ----------------------------------------- / -- -----------------r - j �- - - ----- lJ - r --- - - - ---------------------- ----- —---- ---------------------- ------------- - - -- — — 7 --- - ---------------------------------------------- - -----1-1-------- ------- 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 F.P.C C.