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"—' FOR &FFICE USE: ` ----=------------------ j APPLICATION FOR SANITATION PERMIT Permit No. ---------------------------� --- - ------------------ (Complete in Duplicate) ; ------------------- � - . Date Issued This Permit Expires 1 Year From Date Issued ---------- ------------ -------------------:------ + r Application is hereby made to the SanJoaquinLocal Health District for a permit to construct and install the work herein described. I This application is made in compliance with County Ordinance No. 549. / JOB ADDRESS ANDLOCATION-- � T/ f .5 ..,11d ------------------------------------------------ ------ Owner's Name------ 'r. ------------•-------------- - --/--------------------------------------------------------- Phone.��3-, 1 D Address... ......1-------Rpx...... _Fo,P.Zi ------------------------------------•--•---- Contractor's ------------------------•------------------------ Phone,"Zr I Installation will serve: Residence Apartment House [] Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ i Number of living units: __/--- Number of bedrooms --- .. Number of baths __/_.. Lot size ----.-PO---------------------- Water Supply: Public system ❑ Community system ❑ Privatek Depth to Water Table ---7 ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ AdobeI Hardpan [Ip i Previous Application Made: (If yes,date--------{_.--------) No Ne>Construcfion: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: ,(No septic tank or cesspool permitted if public sewer is availa6le within 200 feet.) N flw .yDistance from nearest well-----------------Distance from foundation--.--__._---.----._ Material________----._.________---------..---,-----____. ! f, 1 No. of compartments ------ ------------------Size--------------------------------Liquid depth--------------------------Capacity----------------------- Y pis I Fi I Distance from nearest well___S�--...._Distance from foundation---/0--_.-_._..Distance to nearest lot line___ 61 Number of lines_______,_________ ___________Length of each line_�4--4 =4.['Width of trench._.. ..__._-__ ._-_---- Type of filter material____"_RQjW--------Depth of filter material___ ------------Total lengtli_._.y/OD------------------------- Seepage Pit: Distance to nearest well_______________-....-Distance from foundation_=------------ ---.Distance to nearest lot line------------ ❑ Number`.of pits-----------------------Listing material-------------------._Size: Diameter-----------------------D�ept1�--------------------------------- .R : Cesspool: Distance from nearest well----------------- from foundation------------------- Lining;material______ __________________________- [� SEze. Diameter____.---------- --- Depth ----------- ----------------------------- - Liquid apacity ---------------------gals. —P-ivy:�'" " '�Distn'ce from nearest well+. _.. Distance from nearest bui{ding---- -------- __________________ ❑ Distance to nearest lot line______________________ ------------------- -- -:---------------------------------------------------•------------------...-- Remodeling and/or repairing {describe:__._ __ "' r ,�� �1_ _ --------. ---- = ----------- _ - ---- f y ---------- ------------------------------------------------------------------------------------------ ---------------------------------------------- ------------------------------ I hereby certify that I have prepared this application and that'the.-work-will be done in accordance with San Joaquin Count y 4 ordinances, State 1 and rules and regulations of a San'Joaquin Local Health District. ' r _ (Signed)------------ -- -----Owner and/orContractor) --.. - - . (Plot plan, showing size of lot, oca ion of system in relation wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY------------ ----------------------- --=---------------------------- DATE----------------------------•--------- --------------------- REVIEWED BY ---------- DATE.--/- :---7-6 7-= J - --- BUILDING PERMIT ISSUED----------------- -------- - - ------------------------- ------- --------- --------------- ---- --._ DATE----------------- ------- t Alterations and/or recommendations:---------------------- l �. --------------------------------------------------------- ----------------------------------------- --------• ----- ------ --------------------------------------------------------------------------------- ------••-------------•---- ---------------------------------- ---------------------- -------------------------------- _.___..-______._._ --------------------____..__________.._...._.____r.._.-------.---------------------- ----------------------------------- r FINAL INSPECTION BY:------- _ Date--------------------- ! Y� r SAN JOAQUIN LOCAL HEALTH DISTRICT t 1601 E.Hasellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.CC.