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! OFFICE USE: _ _.. a � "9 --------------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. ..... ...........•_. ----__ (Complete in Duplicate) - ---- ---------...- - -. -� ------ - Date Issued __�� --�5-- "__ . --_- ".____- _-_ This Permit Expires 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 compliance with County Ordinance No. 549. w JOB ADDRESS AND LOCATION-------- _ d-----•---(' .� V iC�L ----------------------------------------- �, s j --- Phone_ _ t�_.�_��--�-�_ Owner's Name_--------------------v+/_/_�//--/z---------E----- )--------- �--- -- --- --------------- ---------------------- Phone ..0... Q, I-'��'r-=-------•---- -- ---- --- �r/��-"--------- •-- Phone.__ . Q_ Contrac#or's Name--------------- / -�-�-fj,�--- -°�--- ---------- ------------------•----• Installation will serve: 'Residence 2r"Apartment House FICommercial ElTrailer Court ❑ Motelr E] Other ❑ ` , Number of living units: f---- Number of bedrooms ---� Number of baths _.�_-_ Lot size _. ----- � �'$6 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 [3—'Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (if yes,date..------ -------) No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ 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"---_-"_------.__.----..__"-_-__-__..__.._.__--. ❑ 4 Disposal -------- -Disposal Fiel j Distance from nearest;weh----_- ---._.Distance from foundaficn_.sx ___ Distance to nearest lot lig__ .-_..__ T J. � 61 --.---------Length of each line---,---0._/------------Width of trench-----a"�-- ------ Number of lines_____".___�...__ ------ Type of filter material"_��/�G�.---Depth of filter material._✓ "---___.._.fatal length-------- -"r ' Seepage Pit: Distance to nearest well-.----------------.---Distance fro foundation--- Distance to nearest lot line_ 1A ' ' f W-11Dumber of pits._..:]"-.-_,_'_".__Lining material..- , -Size: Diameter__J33-`�-_-----Depth.._.." _ r----- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material-------------------------------------- F1 Size: Diameter----------------- ---------------- -Depth----------------------- ----------------------- ---Liquid Capacity--------------------------.gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest bui4ding----------------------------------------- ❑ Distance to nearest lot line.----- -------------------- ------------------- ------------------------------ ------------------------------ Remodeling and/or repairing (describe]:----- � ---------�7* """""""" -- --------------------------------- - - -------------------------------------------------------------------------------------------------------"--------------------------r---------------------------------- I hereby certify that I have prepared'Als application and'that the work will be done in accordance with San Joaquin County ordinances, State laws, and r and regulations of the San Joaquin Local Health District. f �/ G� ne nd/or Contractor] (Signed)--- jrL '` _. --------------------------------- -- - - By:--•------------------ - ------------------------------------------Title -----------------% - :.per o.�c-.cam+ { 1 (Plo+ plan, showing size of lot, location of sys+ in relation to wells, buildings, etc., can be placed on reverse side]. FOR DEPARTMENT USE ONLY ---------------------------------- ---- ------ -' �4-4�-------------------- APPLICATION ACCEPTED I3Y__..�__-- �--�--�----�---- - - DATE �-� REVIEWED BY----- -------------------------- ------- ---------------- -- --- DATE---------------------••---------------------------- --------------------------------------------------------- -- -- BUILDING PERMIT ISSUED------------------------------------------------------ -- , -------- DATE------------------------------- 1 . / sc � �^ -� ---- ��-------- Alterations and/or recommend ations:_---5.-°-_t(".`---�----------1- 1 $ "-" """""" " ---------------- ----------•-------------- ---"------------------------------ ----------- -------- ------------------------------------------- FINAL INSPECTION BY:-----Q -1--... Date.- I P �� ------ -------------------------- --------- 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.CO.