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FOR OFFICE USE: ------------------------------------ ---------- --------- Permit No. _ -__,____--_-_.__ APPLICATION FOR SANITATION PERMIT ----------------------- (Complete in Duplicate) �C 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 is made in nn co m fiance with Count Ordinance No. 549. `'`' oF-----�----AMPORT-.__�l1/AX----�-R_Pa -- A---N---- RQc�P JOB ADDRESS AND LOC ......__----_-�-_ Owner's Name------------ ��ION --"'-'. .............. - ) Phone.- a�)-63Q Address................. g�1 1�lQN _R>= 1-v-� 1-E}�t _�� ) . L Contractor's Name-----&W&fM----------------------------------------------------------- ----------------------------------------------------- Phone---------------------------------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ---1--- Number of bedrooms -1----- Number of baths A-_-- Lot size _--_-' +�QQQ---- 0------_-_-f-------------- Water Supply: Public system E] Community system Private El Depth to Water Table ./Zft. Character of soil to a depth of 3 feet: Sand Gravel ❑ Si dy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date--------------------) No New Construction: Yes ❑ No FHA/VA: Yes ❑ No 2-- TYPE TYPE OF INSTALLATION AND SPECIFICATIONS: J (No septic tank or cesspool permitted if public sewer is available within 200 feet.) `N Septic Tank: Distance from nearest well---5�__.-------Distancp from foundation-10--_-.---__--Materi I__.CNV {ET.� VP - ......... v. �/ J K" No. of compartments_--_Z_-_-__.___Size__ x.I�.x._,T___Liquid depth--.-/-- -_Z__-__--Capacity___I P...... Disposal Field: Distance from nearest well_.SD._-_-Distance from foundation-___1Q.-.----_.Distance to nearest lot fine---_'-��__..--___-- [� -------------------Length of each line__---_ a___`___ ------Width of trench 2 r' Number of lines_._.__.____.-- i� -t--.-------- Type of filter material---R0__Cj--_Depth of filter material____-_ `�._.--.-___Total length---------------- ------------------ Seepage Pit: Distance to nearest well----------------------Distance from foundation_-__--..-__.--_-.--.Distance to nearest lot line__.-_---_-.--.--- o ❑ Number of pits------------------.---Lining material------.----------------Size: Diameter------__._..----------Depth_-.____-------------_---._--._ Cesspool: Distance from nearest well-----------------Distance from foundation---------..---------Lining material-----...........___-_.-._-_-------_. Size: Diameter---- - ----De th---•------------------------------------------------Liquid Capacity gals. Privy: Distance from nearest well.-----------------------------------------------Distance from nearest building ❑ Distance to nearest lot line--------------------_- -------------------------------------------------------------- ------- G 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 Joa {uin Local Health District. (Signed)--- ------- - ------___----------------------------------------------------- ------------------(Ow r r (Owner and/o Contractor) BY� - -------------------------------------(Title)------------------ ------ ------- --- ---------- ------------------------- -- (Plot plan, showing size o lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-----FA R-- ------------------------------ ---------------------------------------- DATE-------7-- Z ---------------------------- REVIEWEDBY--------------------------------------------- ------------------------------------------------------------------------------- DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED_---------------------------------------------------------------------------------------------------- DATE.-- ------ I'' Alterations and/or recommendations------------------------- --------- ---------------------------------------------------------•--------------------------------------------------------------- -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ----------I-------------------------------------------------------------- -----------------------------------------------i------_-----------------------------------------------------------------------------•----------- ---- - --- -- •- ------- -- - -- - - -- -- --------- ---- - -•-•-- - --------------------------------------------------------------- ---- ------- -_ ----------- FINAL --- -- - FINAL INSPECT N BY:. ---.----_-- - 9.716-.-. Date SAN JOAQUIN tOC*- HEALTH DISTRICT 1601 E.Haxelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.CO.