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FOR OFFICE USE: - F � - ----------- ---------- --- �G_---.__--- -c�.___. APPLICATION FOO- SANITATION PERMIT Permit No. - -- ---------- ----Z.-t! S � 7� � - - - .. --- � - - (Co"mplete in Duplicate) Date Issued .-.•.-.•_-- ------------------ --!/ -------- --- 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. r ThIs application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND_LWATION-----------_.... __3___ -_ Owner's Name.------•-------•....---- }•---- Phone.................................... I Address. y-� c- --•------- .. I Contractor's Name_______ ___ ____ •--- E Phone `r Installation will serve: Residence Apartment House ❑ Comm�ial ❑" Tr er Court ❑ Motel ❑ Other ❑ l of living units: __ ._ umber of bedrooms _ ._ Number of baths . .... Lot size _ _ 4— 'Number t Water Supply: Public system .El -Community system ❑ Private ❑ Depth to Water Table ........ ft. Character of soil to a depth of 3 feet: .Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobem Hardpan ❑ Previous Application Made: (If yes,date--------------------) No ❑ New Construction: Yes Q 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' aret-welL-k0-09Distance from founjatip _ s Material __ a-...Nocompartments ----------- ma.-LS ___ --------- apacy._/ZA;pjQ. Disposal Field: Distance from nearest well---- istance from foundation-------Li4.i------Distant�v�nearest lot line..•.=Vii........ M Number�:.of lines...-------- !l -----------------Length of each line_ Vld. - ot`frrench.__._.� --'-'----___.------ W ' Type of filter material._.., +!16____Depth of filter material------ ,�-_.__Total length__.....f_-s1.- -_'_____________ ,,� }� - 1 i Seepage Pit: Distance to nearest well---WO-s1k-Distance fro fou dation__-_._t �__.Dis Lance to nearest lot line---- - ------ 1A,9 -J tNumber of pits-------- Lining material_.___ -Size: Diameter__ _ pth_-.-------- -,_.ice,! kj Cesspool: Distance from nearest well-----------------Distance from foundation__.-___.____.______.Lining Ierial------------------------------------- ❑ Size:.Diameter.-- •---------------------------Depth----------•-•---------....------------------------._Liquid Capacity .......gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building--------------------------- s ❑ Distance to nearest lot line Remodeling and/or repairing (describe)____________________________________________________ {-----------------------------------•---•-------•----------------._...----------------------•--.. ---------•----------------------- •--- ---------•---•----------•-- ---------------------------- --------------------------------------•-•--•------- --------...-•-----•-----•-----•---...-----•---------•-------------....--•------•-••---------•------- 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. (Signed) ----------•---------------------•---------------------------------(Owner and/or Contractor) �Y= ... ...-- ---- ------------------------------•-•-- --- - (Title) (Plot plan, showing size f lot, )oc ion of syste ion to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY.... xr,, -------------------------------------------------------------------- DATE-----7-�-�--�---Z-•-----------.._..---------•_... f REVIEWED BY------------------------------------------- --------------- .-.-.-.-.-.-L.-.-..--------------_-- DATE BUILDING PERMIT ISSUED---------------•----•-------------------- - ------, ----------;--------------.._. DATE----------------------Alterations and/or recommendations:__---_ b z-___------,�-------1. °---•--••-------- .__,. ---------- . -----•.......... ......L( - ^ - 3n p 1 FINAL INSPECTION BY:...... ..s._ ---------------------- -------------- Date ---------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 144 Sycamore Street 405 West 9th Street r 7,// Stockton,California Lodi,California .Manteca,California Tracy,California E8 9 REVISED 8-89 EM 8-6t AILA$ s v a+'y