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FOR OFFICE USE: ----------------- ------ -------------------w'`"__. APPLICATION FOR SANITATION PERMIT 1'� Permit No. .... ----------------------------------------------------- (Complete in Duplicate) . Date Issued __5.....�Z_6>' .............__--___ _. _-_-.-__. _-_ -------------- __-- 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 County Ordinance No. 549. JOB ADDRESS AN ATION _______________ -K'�j---.�=----------------- � --------------------------------------------------------------- Owner's Name--- �" lr�i" .�'� �.-------1�`/1��---� ------------------------------------------------- ---------------------------------------- Phone----------------------------------.. Address --_ .....-- G � �' -------- C, Contractor's Name .70�Z'' ��`- " -------- ``-- -----------rt-------------------------------------------- Phone................................... Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ___ Nu ber of bedrooms __! Number of baths-._-- Lot size, " J,r ----//.. Water Supply: Public system DVCommunity system ❑ Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sand Loam ❑ Clay Loam ❑ Clay ED] ob ardpan I-]Previous Application Made: (If yes,date__-_-_______--) No New Construction: Yes El 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---------------------------------.._..._.._----_. J44/ �/✓ ' No. of compartments----- -------- -----------Size-------------------------------Liquid depth------------------------Capacity----------------------- Disposal Field: Distance from nearest well.___-'"'__._Distance from foundatiop__-1� _�---.Distance to nearest lot line___s--_._�.. 3 If �i ,[ j,�"j! Number of lines.___________t.__ Length of each line. .___ _ Width of trench._-. _,_____________________ j Type of filter material__-.___&_0K IIepth of filter material_ ____. ____..__Total length--. ._._-_--_.- Seepag Distance to nearest welL____�'.-_-.___-Distance, m yclation__ G�.�___.Distance to nearest Iqt line-��_--_--._ 0 Number�of pits____--_.-._.-__---Lining material/_WC 1--___-Size: Diameter-7- Depth__��.-- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material-______-..-.._--_-_-------_-_----_.__ ❑ Size: Diameter---- ------------------------------Depth------ ---------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well .............._-____.___- ----_Distance from nearest building---------------------------------.---.-.-. ❑ Distance to nearest lot line------ ---------------------------- ------ Remodeling and/or repairing (describer- ------� - ----------------------------__---------------------------------------------------- -------------------------------------------------------------------------------------------- ------- ---------- ------------------------------------ -------------------------------------------------- ----------------_------------------- ------------------------------------------------------------ ----------------------------------------------------------•----------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- I hereby cerlws, that I have repared this application and that the work will be done in accordance with San Joaquin County ordinances, $t e an n regulations of the San Joaquin Local Health District. (Signed)------ --- -- -- ------ ---- I--- ------ -------- -- ----- ....... ------------------------------------------------------------- - --- - (Owner and/or Contractor) By:--------- - -- - ---------- - ------ ------ ------------------------------------(Title)----- - ----------- - --------------- (Plot plan, sh wi size of lot, ocation of system in re ation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------- ------------------------------------------------------------ DATE----------- j 3 /-------------------- REVIEWEDBY------------------------------------------------- ------- ------- ------ DATE----------------------------------------------------------- BUILDING PERMIT ISSUED-------------------------- DATE -------- ------- Alterations and/or recommendations:----------jf_----��Yr ------ LAIC-41__.11--------- ...........(1_/N�._ ------------------------------------------ --------- --------------------------------------------------- -----------------------------------------------------------.----------------------------------------------------- ----------------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ---------- ------------------- -------------------------- -------- ------------ ----------------- - ------------------------------------- --------------------------- --------------------------------------- ------------- --------- ------------ ----- ------------------------------------------------ --------------------------------------------------------- ------ ----------------------------------------- ---------- ' FINAL INSPECTION BY:.---`------- ------ -------------------- Date---------- 0-- .. - SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.CC.