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APPLICATION FOR SANITATION PERMIT Permit No_."3� 0._ __ V (Complete in Duplicate)Al �0 Date Issued _!_ -L1_7 Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This applicafiori is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION � O } � -------- ------- -- ---------------- ---- ---------- .-------- �_ _ ------------------ --- Owner's Name-----------Fi`4Q,1--•-------.HAM-FT ---------=-- -- ------------ -------------------------------- ---------- - -- ^^�� F Phonek-----_s -q_ p � ------------------------------------------------------------- ----- --------------------------------- ------------------------------------•---------------------------------Address------------- -------------�Amra Contractor's Name--.--- 'aR .r1----------------- -------------------------------------------------------------------- Phone----•----------------------------- Installation will serve: Residence j!j' Apartment House ❑ Commercial ❑ Trailer Court [] Motel ❑ Other ❑ j Number of living units: --I----- Number of bedrooms -3-- Number-of baths _1____ Lot size ---------5-P----X-15 Q____________________ Water Supply: Public system ®-"Commursify system ❑ Private ❑ Depth to Water Table 60_ ff. I� Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe jEr'Hardpan ❑ Previous Application Made: Yes ❑ No New Construction: ,Yes 9R`_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_______________________________-_-__-______-. ✓�xtjW1 N CT No. of compartments--------------- ----------Size------------------------------..Liquid depth--------------------------Capacity-----------•----------- Disposal Field: Distance from nearest well_-----_------------Distance from foundation-----.--------------Distance to nearest lot line--------.--._.__. ❑ Number of lines-----------------------------------Length of each line-----------------------------.Width of trench----------------------------------- k :exi Type of filter material-------------------------Depth of.filter material----._____._.________._Total length------------------------------------- � s Seepage it: Distance to nearest well_.N:�_N r-___Distance from foundation____ ---------Distance to nearest lot line_______ d LJ' ii � - - ` Number of pits-------- Lining maferialL 11%'._ _ a(Wze: Diameter-__-_ p � I I Cesspool: Distance from nearest well________________ Distance from foundation--------------------Lining material _.-..-________.___.__ _ ___. ❑ Size: Diameter----- --------------------------------Depth----------------------------- ---------------------Liquid Capacity-------------------- gals. Privy: Distance from nearest well--------------------------------------------------Distance from nearest building..____.-_______________________.________- ❑ Distance to nearest lot line---------------'---------------- ---------------•--------------------- -------------- ------------------------------------------------------ } i a Remodeling and/or repairing (describe):------- �1 1>� - ------` C ..------_-X�-STI-AtGr--------5yS7_E1-1----------------------- --------------------------------------------------------------------------•-----------------------------------------------------------------------•-------------------------------------------------------------------- f r ________________________________________________________________________._-_-__________________--__________________________________--_-_--_ _-. ---.-. j I hereby certify that I have prepared this application and that fhe work will be done in accordance with San Joaquin County ordinances, State laws, and rules and lations of the'San Joaquin Local Health District. (Signed) ` ig )--------- - (Owner and/or Contractor) By--------------------------------------------------------------------------------------------------------------------------------------(Title)-------------------------------------- --------- -- ---- (Plot plan, showing size of lot, location of system in relationtowells, buildings, etc., can be placed on reverse side). R FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------- •O------------------------------------------------------------------------ DATE-------- =i ----------------------- REVIEWEDBY------------------------------------------------------------------------------------ --------------------------------------.- DATE---------------------------------------------------------- BUILDINGPERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE------------------------------------------------------------- Aiterafions. and/or recommend tions------------------------- ---- ------ -- --------------•-•-------------------------------------•------- -•------------------------•-------- ------ ----------------------------------------------------�tT----- -------- ------ ---`-------------------------------------------------------------------------- --------•--- ---------------6,K.- ----- -- -------------------------------------•------------- ------------------------------------- --- ----------------- ------ ----- ---- ------------------------ .� FINAL INSPECTI - - - -l�t- C------- ------ Date------- - _- ---- -_---7--------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Sfree+ 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California E5-9-2M Revised 1.57 F.P.CO.