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FOR OFFICE USE: _ -------------------- h' '---------- 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 is made in compliance with County Ordinance No. 549. f '� JOB ADDRESS AND LOCATION___.��.�`/_-_s S.- _U��/`��1f'� 4 -- - - Owner's Name------Ic-4-------Jro -a------------------------------------------= ---------------------------------------------- ------------- Phone------------------------------------ Address-------nra-lw%---------'-------------------------------------------------------------------------------------------------------------------------------------------------------------------- Contractor's Name-----�g_-��- eOi9y�,4_00-----------------------------------I--------------------------------------------- Phone----------------------------------- Installation will serve: Residence Apartment House ❑ Corpmercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _ ___ Number of bedrooms__. Number of;baths _. Lot size f,�j; 1%---------------------------- Water Supply: Public system ❑ Community system ❑ Priv +6 e th to Water Table?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 Vg-- New Construction: Yes [+--No ❑ FHA/VA: Yes g;— No ❑ 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.-/040._Distance f�r°m foundation__/g9-______--.Mate�al 1"�L��E ---------------- No. of compartments__,�.------- -._-___� '�X46Size. _=�)e-"____Liquid depth_�/�_______________Capacity_e,,0.P------ Disposal Field: Distance from nearest well._/0A_..Distance from foundation.Ao-- Distance to nearest lot line__.-____. ®-- Number of lines.----02_ _`____ ength of each line-,;v__p ... ---------------Width of trench.i - ._____._.________---- Seepage Pit: Distance to nearest well__ fp__J__Distance from fo ndation---�,-_!__.Distance to nearest lot •ne_�.Gr_ .. 211- Number of pits----.•______.-_ _-Lining material_;_ Size: Diameter_x.________Depth ,A"— from foundation- __.--_._______--__-_-_--_-. Cesspool: Distance from nearest well.____._.__.____Distance . ro g material_-- ❑ Size: Diameter- ------------ ------ ----Depth------i-------- -- ------Liquid Capacity----------------------.....gals. • Privy: Distance from nearest well------------------------------------------- -._ _Distance from nearest building----- _.________-_-________._.____-.-. ❑ Distance to nearest lot line-- --------------------------------------- ----------------�---.---------------------------------------------------------------- ---------- 57 Remodeling and/or repairing (describe):------Cwe_W-----1 f1��----- >11G 1 ------------------------------------------------------- -- ------ -------- -------------------------------------- ------------------------------------------- -•----------- -----••------------------------------ --------------------------- -------------------- ----•--------------------------- --------------------------------------------------------------------------------- ---------------------------------------- ----------- 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)--------------------------- !{ yl L� --------------------------------------- --------��r Contractor) By:------------------------------------------ ------- --�� '-----------------------(Title)--t *�� -------------------- -- ---- ------ (Plot plan, showing size of lot, location of system ' elation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY p APPLICATION ACCEPTED BY = ---- -------------------------------- DATE.. �"4'( . REVIEWEDBY--------------------------------- ----------- ------------ -- ----------------- ---------------------------------------- DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED-------- --------- -••------------------------- DATE-----------------_---------------------------------------- Alterations and/or reco mendations ___'----- - a� ��"---! a-=•--• '----� -----�---�---x--- --- - - -----e----••-4------ -'------- ---------------------------------------- ----- ----- ------------------------------------- ----------------------------------------------------------•----------- = �= ---------ram„-�d-- � ► FINALINSPECTION BY:.--- - -- ----- -- -------------------------------- - Date----------- ------- --- -- ------- ----------- ------------ -------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 000 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,Cclif4ihia Lodi,California Manteca,California Tracy,California F.P.co.