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FOR OFFICE USE: 4 APPLICATION FOR SANITATION PERMIT Permit No. ----- ------------------------------------ (Complete in Duplicate) � ------------------------------- This Permit Ex fres 1 Year From Date Issued Date Issued .- _/8_ 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 Ordinance No. 549. /� 5J&cp 1-0tJ- JOB ADDRESS AND AAT51bM__r -H- �� /CrZ,p / -U.---- t`-----SCK_—0_! -----i--RD--------------- Owner's Name----------- F 1Q 1 ----------------/Zo--------- -------------------------------------------- Phone-------------- --------------------- Address--------- r --- ----- ox---------1057 ---------------jF_GCA4-Qii4--------------------------------------_---------- Contractor's Name--- - •--- Phone----------------------------------- Installation will serve- Residence E] Apartment House E] Commercial Trailer Court (] Motel ❑ Other ❑ 1 A Fr , Number of living units: ___Number of bedrooms __--- Number of bathsr� Lot size ----ALR.F-------------------___--__-_-.--._ Water Supply: Public system ❑ Community system ❑ Private [Depth to Water Table 2-�Tft. Character of soil to a depth of 3 feet: Sand ravel ❑ Sandy Loam ❑ Clay 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-_-----._-__---._____--___--------------------------------------------------- FYo[%; 7 A No. of compartments--------------------------Size--------------------------------Liquid depth--------------------------Capacity.----------•------ .� Disposal Field: Distance from nearest well----5-D--.-Distance from foundation----- --------Distance to nearest lot H Y,! 111 Number of fines__ -------Length of each line---------5- f-r___._._.Width of trench--------- KTotal length----------------------�_---"--------_---_- -r-__-__.-DD • Type of filter material �_r. .__De th of filter material___ . �------ Seepage GC Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line.._.-------._-_ ❑ Number of pits----------------------Lining material-----------------------Size: Diamefer--.--------------------Depth--------------------------------- Cesspool: Distance from nearest weft-------------_--Distance from foundation...........:.._......Lining material-----------------------.-----_---._-. ❑ Size: Diameter------ -------------------------------Depth----------------------------- ------ ------ -------Liquid Capacity----------------------------gals. Priv Distance from nearest well___________________.___..____.__.____- -_.._ Distance from nearest building ----------------------------------------- Privy: ❑ Distance to nearest lot lire------------------•-�----------•- - ---------------- - ------------------- ------------- - --- too 17 ` � Remodeling and/or repairing (describe):--.--- .PvtT-ro&(__-___D _l�Z _ 1 ________ -----------(„2` _--------- -FOB __..___. RC_Qlrrt-rte- D -MI A(------OF------------2P-Q----P-----------------[=�1-0--� =------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------_ 1 hereby . that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, ate la s, aPf s and r ulations of the San Joaquin Local Health District. (Signed -----------------------(Owner and/or Contractor) •------------------------------------• Title -- -- --------------------- (Plo plan, showing size of let, location of system in relation to wells, buildings, etc., can be placed on reverse side}. FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY----- -- - =--------------------------------------------------------------------- DATE------ ----- --------- -- REVIEWEDBY------------------------------------ ---------------------------------------- -------- ------------------------------------- DATE------------------------------------------------------------ i. BUILDINGPERMIT ISSUED---------------------------------------------------------------------------- ------------------------- DATE------------------------------------------------------------- r. Alterations and/or recommendations:---------------_---- ----- ------------------------------------------•--•-----------------------------------•----•---•-------------------------------------- ------------------•------------------------- ------------------------------------------------ ------------------------------== -------------------- -------------------------------------- ---------------------------- ----------------------------------------------•-----;- --•- ----- -----_-------------------------------------------------------------------------------------------------- --------- , - -------------- -- ------------------------------------------ -- ---- --------- - --- ----- ------- ----- FINAL INSPECTI Date -' - SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazollon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.C C. —J