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r --� �^ ` FOR OFFICE USE: _ ------------------------------------------ ---- Permit No."VI i --------------------------------------------------------- APPLICATION FOR SANITATION PERM (Complete 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. This application is made in compliance with Count Ordinance No. 549. j JOB ADDRESS AND LOCATI ______ , __- - ,� __/ 0-, "------------; ------------------ IPhone--------------------------------- Owner s Name----- ---- - ---� ----- ----------- ' Address -� ---- VZ -- -- -------------- Contractor's Name �_`. _ -42 ------� _-1------ �--- -- -- - ------•--------•--- Phone r I , R Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Mot/el ❑ Other ❑ Number of living units: __.1--- Number of bedrooms _-2-- Number of baths --`.- Lot size ---- -Q-- � Water Supply: Public system ❑ Community system ❑ Private ° Depth to Water Table V_ ft. I' Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobexo Hardpan ❑ Previous Application Made: (if yes,date--------------------) NoX New Construction: YesX No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: .W(Nomseptic-tank or cesspool permitted-if-public sewer is available within-200 I ` ll -____--Distance from foundation- !_�_--_____.Material-____ '* �G4-- -- ------------- Septic Tank: Distance from nearest we --Size- ��_1 -----Li Liquid de th------1lK/� - - -Capacityfi ---------- ---- �d- No. of compartments-------c� -----f �- -- - - - q p. 7` ----'-.- -- Disposal Field: Distance from nearest well.- ..--__Distance from foundation-�----Distance to nearest lot j e____ ___________ (* Number of lines------.-7-------- -- Length of each line---- ---- -------------Width of trench----a ------------------------ De th of filter material----- --- -1---Total length of filter material___ - ---- p s Seepage Pit: Distance to nearest well__/l_ _-r__.-Distance fr m f undation_A--`--------Distance to nearest lot line__+ _.- Number of pits------ ` ----------Lining material_-`_ -----Size: Diameter--- .............Depth---CZ ------------- Cesspool: Distance from nearest well-----------------Distance from foundation---------------------Lining material---______..__..__--.____-_--___..___. Size: Diameter-------------------------------------Depth------------=-------------------=---------------- Liquid Capacity gal ❑ Distance from nearest well____________________ Distance from nearest building--__.__--_____---._____-___..._--------. Privy: ------- ❑ 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 Coun+y ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed) - - (Owner and/or Contractor 9 ----- ------ -- (Plot plan, showing size of loft, location of s em in relation to wells, buildings, etc., can be placed on reverse side). I FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------ -____V�-"�- �-------- ----------- ------ DATE-----1/17_ /4------------------------------------ 6?------ - ----------------- --- REVIEWED BY----------- ----------------------------- ----------- ------------ -------- -�------------ ----------------------- -- DATE-- --' ---------- BUILDING PERMIT ISSUED----------------------------------- ------------------------------------------ - --------- -------- DATE----------------- ----------------------------------------- � i Alterations and/or recommendations:_______ __ _________ _________.._-___-- ---------------- ----------------------------------------- ----------------------------------------------------- - _ _ _ - ---------------------- - -------------------------------- Date------- �r - --------------------- FINAL INSPECTION BY:---- 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.R120,