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FOR OFFICE USE: -------------------=--------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. -- fl --------------------------------------------------------- (Complete in Duplicate) Q Date Issued Date issued - ----------- ------------------------- ----- - 7�� _ 4t O - 17 This Permit Expires 1 Year From Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This ap licortS2 #s made incom Bance with ith County Ordinance No. 549. t JOB ADDRESS AND OCATIONE--------.YI---__ __ `_._r!�_--_ �___ _._I�L?� _ � P__ Owner's Name------ ...f _........ . ---- Phone----••------------------------••- 1-0- - ------- - - - - - -- Addre ss-----�419-r - 13L?V r ---------------------------------------- Contractor's Name___-__ ...... ! , Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ___l�__ Number of bedrooms ---- Number of baths _-. _ Lot size ___ _ ___..__X_._�� __________________ Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe CK Hardpan ❑ Previous Application Made: (If yes,date--------------------) No 54New Construction: .Yes 9 No ❑ FHA/VA: Yes ❑ No ❑� � TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted-if--public-sewer-is available within-200-feet.) . s Septic Tank: Distance from nearest --Distance from foundation---/A_________Material_ ,c._.t!!!!:4'f__.. hQ El No. of compartment-s---------- ..........Size---Zo_x_�!__^-----------Liquid depth-----------V--- ------Capacity---X�aP-----, 04� Disposal Field: Distance from nearest well..// 140...Distance from foundation_..0.....___.Distance to nearest lot line_-— ---__--a ❑ Number of lines-----------0(>-._-. _ -�f-------Length of each line-----�X_�a_�___ .Width of trench._-----�_ � u Type of filter material.-_./�___--_--____Depth of filter mater a_____,f __.. o#al length_______ ZP__--_-__--_-_- Seepage Pit: Distance to nearest well_--------------------Distance from foundation--------------------Distance to nearest lot line----------------- -C, ❑ Number of pits----------------------Lining material------------...........Size: Diameter-----------------------Depth---------------------------------' Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material---.-----------------------------.--_1El Size: Diameter---------------- --------------------De th---------------------------------------------------Liquid Capacity alsi i Privy: Distance from nearest well-------------------------------------------------Distance from nearest building-----.------------------------------------ ❑ Distance to nearest lot line-------- ------ -------- --- - --------------------------------------------------------------- ----------------------------- , Remodeling and/or repairing (describe):-- -----------------------------••------------------------------•------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- --- I 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. . I (5igned)----------- ` _ {Owner and/or Contractor] i �..� —By:- = -' _ _ "r+ - - Q------ -------------------------------- ,(Title)_--_:.--- "j (Plot plan, showing size of lot, location of sys�n relation wells, buildings, etc., can be placed on reverse side). FORV31EPARTMENT USE ONLY l APPLICATION ACCEPTED - ----�------- --------------------- - ------------------- DATE-------11-6 REVIEWEDBY-------------------------- -- -- -------- -- - ------------ ------------------------------------------ DATE---------------------------------------------------------- BUILDINGPERMIT ISSUE ---------- --- -------------------------------------------------------------------------------------- DATE---------------------------- - --------- -------------------- Alterations and/or,recommendations:---------------- ------------- ----------------------------------------------------------------------------------------- ------------------------------------ ---------- --------------------------------------- --------------------------------------------------------------------------- ------------------------------- --------------------------------------------------- FINAL INSPECTION :--- - ------- ----- - - ��.�. _,;-._ Dafie-----.-.------- ----------.--- ----------- ......... ---------I-- ------------- SAN - SAN AQUIN LOCAL HEALTH DISTRICT 1601 E.Noxelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.co. l