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r FOR OFFICE USE: ----------------------- I R APPLICATION FOR SANITATION PERMIT Permit No. -------------------------------- (Complete in Duplicate) Year From Issued „D Date.issuedz This Permit Expires 1 I -----------------_---.--.----.-_--_`---_--_+"..."-....._- 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. E e d f'7— Z fv--S3 nJ. ,62u r-"-4—A0 t I JOB ADDRESS AN LOCATION- -- ". -- =rs _ A4- 1✓__ - -------W-p-� v----------------- Owner's Name-- G^ .. ----------------------------------------------- ....... ------------------------- --- Phone---------=----------"------------ ----------- -- Address L'E' v ------------------------------ '- ----------------- - .x I----------------------------------- . Contractor's Name .... ----. Phone----------------------- ---------- - - -tr-- �"u-- $ Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __/-.. Number of bedrooms _- umber o baths __--l_ Lot size - ------------------------ Water Supply: Public system E] Community system E] Private Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy LoamClay Loam ❑ 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 aterial------_---------._.--.-..-.---.-----..----------. No. of compartments _-_--:_._Liquid de th__._"-_- - Capacity----------------------- Dispos Field: �) ` �-� Distance from nearest well_...Sp_----.-Distance from foundation_-- --------Distance to nearest lot line-S f Number of lines-------------/------------ __ - Length of each line---ZA6_1-------------- -Width of trench---.- -_ ---..-"--"-"--"-""-. Type of fitter material--------"- -" -"-----Depth of filter material---..- ... Total length---- ---------------------------- Seepage a Pit: �iu�abee of nearest well:'-_-_-Lining maDteraalce from foundSize:foundation Distance to nearest lot line-____-_-----"-"": r IaL Cesspool: Distance from nearest well________ _ ____Distance from foundation- .-.--.-.Lining material------------------------------------- E --.------ .-.-.-_-_ ---_----- Size: Diameter--------------------------------------Depth------------------------------ ----------Liquid Ca acit als. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building----------------------------------------- �1 I ❑ r Distance to nearest lot line---------------------------------- ------------------------------------ ------r------------- - -------------------------------------------- J, Remodeling and/or repairing (describe):-------------------- -----;----------- 4"`------------a ----: ----••-"----...------------_---------------- ------------ ,PYA-y f —rr'� ---------------------------------"------------------------------------------------------•-------------------------------------------------------------------------------------------------------- -- t I hereby certify that 1 have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, S laws, and rules and regulations of the San Joaquin Local Health District. (Signed)--- ------ ---- -------- and/or Contractor) -�F- •sdrF•ter - - �' ._ -.. ,�� By!-Y --•------�------ - - ----- - - ----ti {Title ~ (Plot plan, showing size of lot, location o system n relation to wells, buildings, etc., can be placed on reverse side). t � FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-- -------- -------------------------------- DATE - �----- �--------- ------------------------------ REVIEWEDBY--------------------------------------------- ---------- - ------------------------------------------------------------------- DATE------------------------------------ --- BUILDINGPERMIT ISSUED----------------------------------- ----- ----------------"---—------------------------------------- DATE-------------t------- ---------------- - Alterations and/or,recommendations--- ---- --------------------------------------------------------------------------"------------------------------------------------------------•------------- ------------------------------=--------------- -------------------------------------------- -----------•-----------------------•--•--•--- ------------------------------------- ----------------------------- ------------------------------ ------------- - --- ------ -- -------------------------------------------- ---- ---------- ----------------------------------------------------------------- -------------------------------------------- -------------------------------- --------- - - ------ ---------------------------------------- ----------- ------------------------------------------------------------------ FINAL INSPECTION ------------=---- Date--- - ------------------------------------------------ SAN ------------------------------ .SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Ha:ellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,CaliFornia Manteca,California Tracy,California F.F.E;G.