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FOR OFFICE USE: _______-_.___.__-_._.___-_____.__________________ APPLICATION FOR SANITATION PERMIT_ Permit No. _ -----------I----------------- -------------------------- (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. QQ � n JOB ADDRESS AND TION------ A'_- -.-i1o_x---, -,-- � `_----- E .sTOVL/�v.Ke �!!!�!''__-_ / � Owners Name 61 �_!ri//� � .Q�_�L"1' ----------------- -------------------------------------------- Phone.��_�_;�__�F-0$---------•- Address------------------ T ------- "_�.7:1�-� --- Contractor s Name............ --- If Installation will serve: Residence EKApartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ___ N ber of bedrooms -4.. Number of baths _,'f__._ Lot size __ G __________________________ Water Supply: Public system ❑ Community system ❑ Private ® Depth to Water Table e✓ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam Ik Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date--------- ----------) No ®e New Construction: Yes ❑ No Ugol FHA/VA: Yes ❑ No E;4— TYPE OF INSTALLATION AND SPECIFICATIONS: (No sieptic tank or cesspool permitted if public sewer is available within 200 feet.) / Septic Tank: Distance from nearest well_-, -0___-__Distance from foundation__`--- f__"___-.-__._.Material_...__��`�sT_______________ 18 No. of compartments---_-.---J--__.-____-___Size_AX-4G.X__k----.---Liquid depth__- _...... ----Capacity... ---qa:r Disposal Field: Distance from nearest well_-X511_-_`._Distance from foundation._�.J .F_--__.Distance to nearest lot line_._....... [g Number of lines___------ ______Length of each line__-'C2_- .___ --------Width of trench._,,:'__"¢_-----.- ---------- Type of filter material__.` ,t�OCr�C Depth of filter material__ZY:----.------Total length-------�- ............._ Seepage Pit: Distance to nearest well----------------------Distance from foundation....................Distance to nearest lot line____--__.__-_--- 'Q u ❑ Number of pits-------------- ---_---Lining material-_-_ "----------------Size: Diameter-----------------------Depth----.._-.-______--_--.--_---__ + Cesspool: Distance from nearest well-------------- from foundation--------------------Lining material---------------------------.----- ___. Size: Diameter----- .-------------- ----------------Depth-_-__.-_--_-__--____ ______________-___-.Liquid Capacity __g,als. C Privy: Distance from nearest well_--------------------------------------------_Distance from nearest building.----------------------------------------- p ❑ Distance to nearest lot �line------ -------------------------------------------------------------- ------------�--------------------------------------- ------- -------- f RemodelingA nd/or repairing (describe): __ ?-Uf ,tl1TI �___. � t ?.__. /'Q.tP.I '� l�P `_----------- -------------0-1-'- - -------- c ilCdCt!-----------------------------------------------------------=------------------------- --------------------------------------------------- P -___ _ -_ �------------ --------� .__ _._� -__------------ -°`� - -v--t�------- - -- } c�-t�. ----- ----- ----------- --- ---- I hereby certify that I have prepared this application nd that the work will be done in accordance with San Joaquin County ordinances, State laws, and ries and regulations- of the an Joaquin Local Health District. i� 7 (Signed) - = I------------ ..... ---- so? <s-------- ---------------------------lowner and/or Contractor) BY: - - ----------------------=-------------------------------------------------(Title)----- - - - - (Plot plan, showing size of lot,_I tion of. sys+em in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_------------------------------------------------------- -------------------- _____. -_ .-__ ____ DATE____ -____ -------------------------- REVIEWED _ REVIEWED BY - - - DATE T`1 >- ------------------------- ----- BUILDING PERMIT ISSUED--------------------------------------- ---------------------------------------- :..:. ---I------- DATE---------P---------------- -------------------------- Alterationsand/or recommendations:-------------------------------------------- ----------------- ------ ------------------------------------------------------- ---- ----- ------------------------------------•--------------------- ------------------ -------------------------------------------------------------------------------------------------------------------------------------------- -----------------------------------------------------------------------------------------------------------------------------------------------=------------------------------------------------------------------------- ------------- --------------- --- --- ---------- --- - ----"=- ------------__--------_-----I--------------------------------------------------------------------------- -- -------- --- ----- -- ----- ------- --------- --- . ------------------------I------ ----- ------------------------------ ------ ------- - -FINAL INSPECTION BY------ -- - -------------- _--------------- --------- Date---- ----- - ------------------------ - - --------------- 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.CO.