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FOR OFFICE USE: / U --------------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. -;?...�L/_�!� -------------- ----------------------------------------- (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 Ordinanc No. 549. —Z Q-4-e-1,11- Cal JOB ADDRESS AND LOCATION------ Q 1 r! l'' �" f' "t' S._� ' Owner's Name--- ---••--------------- --------------- ------------ � ---------------------------- -- Phone---�-----------a--�-�-�--`� fiiAddress. _ -- t °� c-SRS~-7------------- �--_"_'-------,�e_c-'", C _ l_'_( Contractor's Name - a r r. 5 ------- -�t-- ' N s-R------------------------------- -------------------------------------------- Phone----------------------------------- Installation will serve: Residence [ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -------- Number of bedrooms __--!;;� Number of baths _____!__ Lot size --------f_A--a__k_!_a_.�_______________________ Water Supply: Public system ❑ Community system ❑ Private ❑ Depth to Water Table J.-l_ ft. Character of soil to a depth of 3 feet: Sand ffl" Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date_------- ----------) No []-- New Construction: Yes ❑ No ❑— FHA/VA: Yes ❑ No E"', 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__�4U_----Distanc? from foundat*n___/8_---__-_-Material______�_"_�--- --- __"�—:_- (� No. of compartments__-,.�_______________Size_3� _x__`� _?�.___Liquid depth____V__ii--_____.Capacity._.__________________ Disposal Field: Distance from nearest well-,/-P.O. __-_Distance from foundation---_Z�'..........Distance to nearest lot line___ [✓f Number of lines------------- -a_________________Length of each line_____6a_�.____�_`____._.Width of french--------_2.4�__"_______________ Type of filter material----- _____Depth of filter material_-_� __________Total length---------/_J_v____________________ Seepage Pit: Distance to nearest well-----------------.----Distance from foundation--------------------Distance to nearest lot line----._________-__ ❑ Number of pits-------------- -------Lining material-----------------------Size: Diameter-----------------------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 (describe):--------------------------------------------------------------------------------------------------------------------------------------------------------- --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------- ------------- -------- ------ t -----------------------------------------------------------------•---------------------------•---------•----------•---------------•------------------------•--------------------•--•------------------------------- ---------------------------------------------------------------•-------------------------•--------------------------------•---------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. �p (Signed)--F- ,,�_ ------p------ -- --'`--'-----'--- --------------------------- --I----------------------------------------------------------------(Owner and/or Contractor) By: -U `9` ----- s1-c -- ----------------------------------------------------------------------- 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--- - - DATE �`YS�' - ----- REVIEWEDBY-------------------------- ------ - - - ------ ------------------------------ --------------- ........ DATE------------------------------------------------------------ BUILDING PERMIT ISSUED------------- - DATE. -------- Alterati ns and/or ecommendations:____ b l /per __-_icarr`_.____ t___ _ ,.__, _____a.ri ____.�'�..___�' _�_cr_._____ ;, / !/ ,�s y - ' ----------- ' Lf '' -- --- � ��'°d ------ ------------------------ --------------------------------------------------------------------------- ----------- ------- ------------------------------------------- ------------------------------------------------------------------------ ------------------- ---------- -- -------- ----------- ------- — -------------- ------------------ --------------------- --•------------- ------------------ --------- - ----------------------- FINAL INSPECTION BY:--- /f t�--- -------------------- Date----IP b - �, N AQUIN 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.