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FADROFFICE USE: �� + C . ----------------- ------------------- - ------ :3Q _..._..____________ --------- APPLICATION FOR SANITATION PERMIT Permit No. a2. . ~ ------ ----------------- (Complete in Duplicate) This Permit Expires 1 Year From Date Issued Date Issued.l9_=_/ 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_ D ,+ � r - ( Owner's Name- --- ------- ----------------------------------------------- - ------- °---•-----•------------------------- Phone----------------------------------- Address----------•---_------- Contractor's Name �----7 ------------------- - -------------------------------------------- ---------------- Phone!.................................. Installation will serve: Residince ®'Aparfinent House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of loving units:__' -_ ber of,bedrooms _ __ Number of baths __ ___ Lot size ._S5 __a`.__f7J^#-------------------__ __ r Water Supply: Public,system Ircommunity system ❑ Private ❑ Depth to Water Tabled ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: (If yes,date.----- ._t) No 2r New Construction: Yes ❑ No &�FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (Ne setic tank or cesspool permitted if public sewer is available within 206 feet.) { VD11111 Distance from nearest well_________________Distance from foundation--------------------Mater.ial____T_...------------------------- ------------ No. of compartments------------------ -----Size-------•-------•---------------Liquid depth-------------------------Capacity---------- ------------ Disposal Id: Distance from nearest well.-__ _.__Distance from foundation_th._�___.____.Distance to nearest lot linetS _______ 1 Number of lines____ _________ ___ Len th of each line '- .---- ---- - 9 �-- ..Width of french----"�-�:4----------------- Type of filter material'TO.G_,_'t--------Depth of filter material_)t"_`'___._____-Total length____- -- 0-`---------- Seepage Pit: Distance to nearest well,f---------------------Distance from foundation---ZO.............Distance to nearest lot line----1.�____._ Number of its___. _ Linin materia ._. p l--- ----��---- g �La.G.--,t....Size: biameter_,3�3.-- ---------Deptn...._��y ------------ Cesspool: Distance from nearest well--------------_Distance from foundation-----_----_-------..Lining material__._._---_____..___.__._____.____.__. ❑ Size: Diameter-----------------2--------------------.-Depth-------------------;--------------- Liquid Capacity----------------------------gals. Privy: Distance from nearest well----------------------------------------------___Distance from nearest building_____-________.______-_______..____.___._ ❑ . Distance to nearest lot line - ------------------ ---- • -- -- •---•--------------------------------------, --- ------------------------------------------- Remodelingand/or repairing (describe):--------- -------- ----------------------------------------------------------------------------•------------------------------------------------------- 0_ ---------------------------------- ------------------------------------------------------------ -----------------------------------------------------------------------------------------•-------------------------------- 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, an ules and regulatto s of the San Joaquin Local Health District. ------------------------------------------ ----------------------------------(Owner and/or Contractor) f Sy:-----------------------------------------------------------------------------------------------------------------------------------(Title)---------- ---------- -- ------ ---------- (Plot plan, showing size-of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). - rf FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------- i ''� DATE � �5ff---------------------------"� I REVIEWEDBY------------------------- ------------------ ------------------------------ ------------- -------------------------------- DATE------------------- - BUILDING PERMIT ISSUED------------------------ - - DATE. Alterations and/or recommendations:--------flG---L�� ---.1/�---- ---•----•---•---------------------------------------------------------------------- -------------------- ------•---•--------------------•------------------ ------------------------------ ---------------------------------------------....-----------------------------------------------•-•-------------- -------------- ------------------------------- - ------------------------------------------------------------ ----------------------------- --------- ------------------------------------------- ,G f FINAL INSPECTION BY: ., . Date -f� I_ G - -------------------------------------------- SAN -------------- ------------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.0 O. x.