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T-CA Or`FICE USE: ------------------ ----------------- --------- `�Z' --- -_.__ APPLICATION FOR SANITATION PERMIT Permit No. ._../. -------------- --------------------- (Complete in Duplicate) Date Issued ----------------------- --------------------------------- 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 's made in compliance with County Ordinance No. 549. 1'C k ISIDE7 -QUTH Air � 6 JOB ADDRESS AND LOCATION /n� ------ ---��---M�- - o -.. O'T'j p_ ----------------- Owner's v Owner's Name------------_E- -----STI D [ SO/1/ ` ---------------------------- Phone.................................... Address R.7-F,7:1 = x l � ,M ' Contractor's Name---------0-WINJ E�---------- Phone Installation will serve: Residence [-] Apartment House F] Commercial ❑ Trailer-Eeart /-, - tel ❑ Other E]Number of living units: __r___ Number of bedrooms __--- Number of baths ---'--- Lot size ------ ___---------------_----------___-_ Water Supply: Public system ❑ Community system ❑ Private ❑ Depth to Water Table le ft. Character of soil to a depth of 3 feet: Sand Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date--------------------) No Z?' New Construction: Yes [KJ— o ❑ FHA/VA: Yes ❑ No,� �A TYPE OF INSTALLATION AND SPECIFICATIONS: 1 (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic ank: Distance from nearest well_10_0- Distance from foundation_10----------Mater' I E=—jbWC0.> ___-------- No. of compartments-._- -7Z--------Size--- ________ ______ __.Liquid depth__- ----------Ca acit � _. �O--_---__---Distance to nearest lot line_ . Disposal 'field: . Distance from nearest.well._1__f�.-_Distance from foundation.._.... ---.-. Number of lines___._.___._ f� ______Length of each line_____. L _`..._..___.Width of trench._.__:_ _---------------- ------ --___-______-. Type of filter material__ _ ___-_Depth of filter material-__��-___-____-.-Total length-------- f1_._� _________________ 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------------------------------------------ 0 ________-_____---______---_-.-.❑ Distance to nearest lot line------------------------- - -- Remodeling and/or repairing (describe):------------------------------------------------------+_ -- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ 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. (Signed)--------- `-- --------- a� -G ---------- -----------------------------------------------------------------------(Owner and/or Contractor) By:----------------------------•-----------------------------------------------------------------------------------------------------(riitle)------------------------------------- --- - - (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------ r�-j_. .,-Q------ --------------------------------------------------------------- DATE.--- = REVIEWEDBY---------------------------------------------------- ---------------•--------------------- •------------- DATE---- BUILDINGPERMIT ISSUED--------------------------------------------------------------------------------------- ----------.- DATE----------------------------------------------------------- Alterations and/or recommendations:---------------- ---------------------------------------------------------------------------------------•------------------------- --------------------- ------------------------------ ------------------- ------------------------ ----------------------------------------------------------------------------------- -------------------------------------- -------------------------------------------------- ----- ------ ---- ------------ -------- --------------------.-••------------------------------------------------------------------------------------------------------- ----------------------------- FINAL INSP - ---- Date--------- (� ----- ----- SAN . -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.