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FQR OFFICE USE: ` _ rr. APPLICATION FOR SANITATION PERMIT Permit No,----------------------------- --� D-f-'-------------------- _--- {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 LOCATION 9�I '.tt.7" 1 - ---------------•- ----------------------------------------------------------------- Owner's Name------------ -- -��-G-�---------- ---- - ------------------ - - -- Phone_�616---- "'�6_ 3 Address------•....-------•--•-••. I-71 r9 T' 1 ----------------------------------------------------------------••------------•--•--•----------------•-------------___ �[ Phone91"'-V-,-7 Contractor's NameA.R-R1__Sf ._y ...� - ------------------- Installation will serve: Residence•� Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __-___ Number of bedrooms _- - Number of baths _..I_ Lot size ------------------------- Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table -------- ft. f Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam [ Clay ❑ Adobe ❑ Hardpan ❑ r Previous Application Made: (If yes,date--------------------) No [a—New Construction: Yes ❑ No []-''FHA/VA: Yes ❑ No D - 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-- -----1-------S'Ze-- ----- -----------------.---Liquid depth----- ------ ------------Capacity..-------- ------------ Disposal Field: Distance from nearest well------ --------Distance from fcMndafion--_ZP_-----_Distance to nearest lot line----6------ Number of lines-------/--------------------------Length of each Ii X---�a"T T�th of }Tench------ 5 ------------------ Type of filter material-------------------------Depth of filter material----_---------.-__..--. otal length----------.--_-_-_----.__-__..__._---_---- Seepag Pit: Distance to nearest well._-------------_-_Distance froyn foundation--- - _.___ Distance to nearest lot line...C ......... `n [ Number of pits--------I---_-----.Lining material--- , __..Size: Diameter... -3--. _..___.Depth--- '-`.------- v� Cesspool: Distance from nearest 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'lofxline-------------------------------------- --------------------------------------------------------------------------- ----------------- ----- �f `._ l Remodeling and/or repairing (describe):____-� --�---G------- (l_,l.,F�.jr_i/!�__',.._%;Z?__�__�_!'�f/�---------------------------------- ------------•-•----••--•---•--•-------------------------------------------------------------------------------•------------------------- -------------------------- ---- -------------- --------------------- a - ---------------------------------- --------------- "--------=---------- ------------------------------------------•-•-------•--------------------------------------------------------------------- ----------------- ------------------------------------ ---------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ I hereby certify that 1 have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State I les and regulations of the San Joaquin Local Health District. 7 -------------- (Signed) O er and/or Contractor} ---------- ----------------------- BY:------- ------------------------------ }Title} -- a----------------- ------ ------ --------- ` (Plot plan, showing size of lot, I anon of system in relation to wells, buildings, etc., can be placed on reverse side}. i "?,,FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------- ------------------------------------------------------------------ DATE-------- 2 % �r-------------- REVIEWEDBY------------- ------------------------------------------------- ------ ------------------------------- DATE---------------- -,; BUILDING PERMIT ISSUED----------------------- ' DATE - - -=Alterations and/or recommendations:-------- �� .w. - -- ----•-------------------------------------- ------------------------------------------------------------------- ----------------- --------------------------•---------------------- ------------------------------• ----------------------------------------....--------------------------------...._---------- --- ------------- : �: --- < FINAL tNSPECPION BY---------- -- ----- -- -----____-- Date........... __--- . .t: SAN JOAQUIN-LOCAL HEALTH DISTRICT I 1601 E.Hareltan Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,Callforn7a Lodi,California Manteca,California Tracy,California - i F.F,C O. - I