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F R OFFICE USE: ------------- APPLICATION.APPLICATION FbR SANITATION PERMIT Permit No. .C). 4 fe:K 1-/�- -� ------ �- ------ (Complete in Duplicate) -------------------- This Permit Expires 1 Year From Date Issued 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 AND LOCATION -7 2 �1s'r[�----------------------------- ------------------------------------------------------------- Owner's Name--- �' -- ------ - ------ Phone-------------------------------------------- - - - - Address------....9,--40-'� -A .�------------------------ -- ------------------------------ -------------------------------------------------------------------------------------------- Contractor's Name - ` - 7 -•-•--------- Phone----------------------------------- Installation will serve: Residence [g'Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ___— Number of bedrooms _3_.. Number of baths ---I--- Lot size _... _/. -3-.._._-------------------- Water Supply: Public system 44- i✓ommunity system ❑ Private ❑ Depth to Water Table& ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ San y Loam ❑ Clay Loam E] Clay ❑ Adobe ft"`Pardpan ElPrevious Application Made: (If yes,date---------_-------- ) No 0New Construction: Yes ❑ No PR�'_FHA/VA: Yes P4-1765 ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic T k: Distance from nearest well................Dis#ante from,foundationfQ__."-----_----Material--_C ...___-_-_-.._....... No. of compartments..-_e�-__ .___.---_-Size_-_-__�._tX(rk_;Pllquid depth____-4------------------Capacity... Disposal Field: Distance from nearest well._- Distance from foundation-_/Y.............Distance to nearest lot line--(-.5----- Number of lines___.__. .. - [7� --- -----------------Leia%Ih of each line:.76-f - •-. --------- -----.Width of trench -4' " - ._ _------ --.--_.--.- f Type of filter materia;-b(i,t--------Depth of filter material-1j,--------------Total length----/4_................._..-_.-._--- r Seepage Pit: Distance to nearest well_-—------------Distance from foundation &._.---------D' tante to nearest lot line..t ----- .. 2r _Number.,of_pits... .___... _.Lining material.�0-(,-- --- Size: Diameter------------ .' __Depth. _._.. ..----------- Cesspool: Distance from nearest well--------------.--Distance from foundation--------------------Lining material------------------------------------- F1 .-_.-..-_...._..._..............❑ Size: Diameter- -- --------------- ----- -------Depth--------------- -------------------- -----------Liquid Capacity----------------------------gals. Privy: Distance from nearest well------------------------------------------- --- -_Distance from nearest building._--_ -------------------_.---.-..___. ❑ Distance to nearest lot line- ----------------------------- ---------------------------------- ------------------------------------------------------------------- Remodeling and/or repairing (describe):---------------------------------------------------------------------------------------------- -------•-----•-------------- ------------------------- --------------------------------------------------•---------------------------------------------------------------------- ------------------------------- ------ ------------------------------------------------------- ---------------------------------------------- -------------- ----------------------------•---------------•--------------------------------------------------------------------------------------•------------------------- --------- ----------------------------------------------------------------------------------------------------•----------------------------------------------------------------- ---------------------------------- I hereby certify that I ve prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, an lesy.Ind regulations of the San Joaquin Local Health District. (Signed)--------------- ••------------------ - - - - ------(Owner and/or Contractor) By:--------------------_------------------------- --------------------------------------------------------------------------------(Title)---------------------- --- -"--- --- -------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY c °- -0----------------------------------------- DATE i- REVIEWEDBY-------------------------------------------------------- ------ ----------------------------------------- DATE----------------------------------------------------------- BUILDING PERMIT ISSUED---------------------------------------------------------------------------------- ------ --- ------ DATE----------------------------- ------------------------------ Alterations and/or recommendations-------------------------�- ----------- -------------- ------------------------------------------------------------------------------ ("4....................... ---------- � c%- 1----------- ------------------------------------------------------------- ---- ------------------------------- - ------------------------ ------ FINAL INSPECTION BY:..... ... -------------- ------------"------------ - Date------�/�_.lr�:--�� ------- ---------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Ha=elton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.O O.