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FOR OFFICE USE: k -------------------- --------------- ------------------ ' APPLICATION FOR SANITATION PERMIT Permit No. ..4 �....... .. ..... L , � ------------------------------------ (Complete in Duplicate) Date Issued -------------------------- -- This Permit Ex fres 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. P `2 MT-C-A f JOB ADDRESS AND OCATI N------*7 1-----1 G`` = ------- ' ------�7f- -------- - �`•t�----1� ------------------- P I/ Q Phone. Owner's Name--------- _ z - �------ �Gtr/- -- ---- -------------- _ �` ------� ------ ---------------------------- ------- --------- Address------------- `S�C / Contractor's Name lt.ri7 aP E2� [--_ F-Xl?f} Phone--------•---------------•---------- Installation w.ill.serve:. Residence _ Apartment Nouse ❑ Commer ial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __ __ Number of bedrooms J.- Number of,baths ---/_ Lot size -------- ----------------------------- Water Supply: Public system ❑ Community syste '-❑ Private Depth to Water Table ________ ft. r 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 [ ew Construction: Yes ❑ No P-,FHA%VA: Yes ❑ No a_ - - f TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.} Septic Tank: Distance from nearest wet{_________________Distance from foundation--------------------Material.__._ ________- ___ --------------- --------- ❑ No. of compartments--------------------- ----S-ize--------------------------------Liquid depth--------------------------Capacity-------- ------------ \n • foundation ` VS Disposal Field: Distance from nearest well_. �_---__Distance from foundation____!-__..____-Distance to nearest lot line----___.__._____ Number of lines-------/--------------------------Length of each line----------Ce - ---..._.Width of trench------ ` - _ Type of filter material-.-�,R '0-1---Depth of filter material------_/-/f--------- otal length_________ _____________________________ Seepage Pit: Distance to nearest well_._.___ Distance to nearest lot line_________________ ' ______________Distance from foundation-------------------- , .__Lining materia--------------------- - p ❑ Number of pits------------- ---- lSize: Diameter------------------ De tn--------- --------------------- � Cesspoo{: Distance from nearest well-________________Distance from foundation--------------------Lining material------------------------_------------- 1 El Size: Diameter ----------Depth---------------------------------------------------Liquid Capacity----------------------------gals. l _________________Distance from nearest buiiding------------------------------------------ Privy: Distance from nearest well_______________________________ I ❑ Distance to nearest lot line----- --------------- ----------------------------------- -----------------------------------V-------------------- Remodeling ------------------Remodeling and/or repairing; {describe):--------------------------------- -----------------------------------------•-------=--------------- ---------------------------------------------------- --------- -------------•--•---------------------------------------------------------------------------------------------------------- ----------------------------------- ------------------------------ ----- ---------------------------------------------------------------------------------------------------------------------------•-•--------------------------------•---------------- ---------------- 6 ` - -------------------------------- ------ --------------------------------------------------------------------------------------------------------------------------------------------------------------- h+ I hereby certify that { have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules ond regulations of the San Joaquin Local Health District. i ► }( �� ----------------------------------- -----------Owne and/or Contractor) ------------------- �.�+ RY - Tifle (Plot- plan;showing-size,of-lot,=.location-of system in relation to wells,-buildings;--etc:,TcanTbe-placed-on reverse-side).- FOR everse side).FOR DEP fMENT USE ONLY 6 APPLICATION ACCEPTED BY ..!__A r1° ----- ° -'-- -- --------------------------------------- DATE-------17/5-.6e------------------- --- - REVIEWEDBY-------------------------------- ------------ ------ ---------- ------------------------------------------- DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED-------------------------- - ------------------------------------------ DATE------------------------------------------------------------- Alterations and/or recommendations---------------------- - ------------------------•------------------------------------••------------------------------------------------- ..---------- -----------------------------------------------------• -----•-------------------•- --------------------------------- ---------- -------- - ------Z- ------------------------------- ------ --- -- -------------------- ----- ----- FINAL INSP N BY: ..:�.s.. ----- -- ---- -- - Date...--------- �`- " SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Ha:ellon Ave, 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California - � F.P.0 O. � -