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I FOR OFFICE USE: i I - ----------------------------- --- --- - ----------------------------- ---------------------- APPLICATION 11 FOR SANITATION PERMIT Permit No. __5�'-._�1�. ------------------ --- - {Complefe in Duplicate) Date Issued- ----- -------------------------------- ------ This Permit Exdires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Healfh District for a permit to construct and install the work herein described. This application is made in compliance with County Ordiinance No. 549. 4,0,) v!?- 176 / JOADDRESS AND LOCA TIO --_ _-_-(-_ __-- ___-- -- -�__ ._/a-►.__. :w„ Owner's Name------ ----------------- --------------------- ---------- --- -------- ------------- Phone------------------------------ Address- ------------------•---•------Address---------- f.� _.�I. , --------------- �. �`-'' ------------------------ -- Contractor's Name-----_--- FA=s __ :1A x - Phone Installation will serve: Residence [[Apartment House ❑ Commercial E] Trailer Court E] Motel E'] Other ❑ Number of living units: __-1__ Number of bedrooms--_ Number baths _/-___ Lot size __✓��__ __________ ____ ____ __________________ Water Supply: Public system ElCommunity system o- Private Depth t ater Table ___-__-_ ft. l Character of soil toa depth of 3 feet: Sand E] Grave�❑ Sandy Loam Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date---__---------------_I IEV0 ❑ New Con truction: Yes r] No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: _ (No septic fank or cesspool-permitted if public sewer is available within 200 feet.) Septic Tank: ' Distance from nearest well-________________ � compartments -SDII,istace from,foundation_ ____________ --.Material.-.___.______--___-____- ----------- -------------- if F-1 No. of _---- ti�ize.�_ --_-_----- --Liquid de th_______________------____Ca acitY----------------------- Dispos field: Distance from nearest wellf___------ _._Distance from foundation-----l_GC_______.Distance to nearest to�lina__ INumber of lines.-----------_�-.#._______ Length of each line___APe___ _-----!_-Width of trench___2--_-_____--___--___________ " IIType of filter material_______ 3r`� '~'De'th'of<filter material______ Total len th_______!-.-i_ [ -------------------- Yp dli p / 9 d - , Seepage Pit: Distance to nearest well_____ _________________I�istance fromfoundation___________________.Distance to nearest lot line.-____-_______.__ M ❑ g Number of pits----------------------Lining-material- --:` - --_Size: Diameter-----------------------Depth----------------------------- --- U Cesspool: Distance from nearest well----------_------Distancesfrom foun%ation__---------------_Lining material_._.__________________-.____-______. ❑ y , w r _ _______Liquid Capacity gals. S� Size: f?iametefr:-��'4�-------------------------------l�epth----'�-�-----------------------•------- -- 9 p Y ------------------------9 fp Privy: Distance from nearest well---------------- -'--------------------- _........Distance from nearest building-,_--------------------------------------- j ❑ �I - --- ------------------------------------ Distance to nearest lot line---j-:�-�_-_-�- -�-- -- �-. -,--.�--.-----=�-•--��----------=----------- � do , Remodeling and/or repairing (describe)•----- , i qN' --------- --•---••----•- _- ------------------- ------------------•-- -------:------- `mss - --------------------------- $ ------------M1-- ---i - ------- -- - -------------------------------------------- , ---------------------------- ------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------- --- 1 hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County r ordinances, State laws, and rules and regulations oa-IT uin Local Health District. (Signed)-------------- --- --- -.-----------------_-- ---------------- ----------------------------------------------------- r and/or Contractor) • _---=n ---- Ti+le------------ ---- ---------------------------- ------------ - - (Plo+plaplan, showing size of lof, location of Sys+em inlls ildings, efc�can'be placed on reverse side). dl' ' FOR DEPARTMENT USE ONLY ' APPLICATION ACCEPTED BY____C I ____________ DATE_____- REVIEWED BY -------------------------------------- -- ------------- -- ------- DATE BUILDING PERMIT ISSUED--------------------------------------------- =---------------------------------------- ------- DATE----------------- --------------- I Alterations and/or recommendations: )-`----------------•------------------------------------ I I , ------------------------i---------------------_------------------------------------------- --------------------------------------------------------------------------------------------------------------- -- } ;), ---------`-------•-------------------------------------------------------------"------------------------------------------------------------------------------------------------------------------------------------'-_..._ ------------------------ -- -- --------------- -------- ------ M- - j ------------------- ---------- --- ---------- ----------•---------------- - - -- - - ---- ------------ ------II----------------- ----------------------------------------------- ----------------- -- -------- ---------------- FILIAL INSPECTION BY:. . fir/, ;- - !ei f°` ------------------------ -----._. Date----- �------------ - - - SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazellon Ave, 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.0l-7. _ 3