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t-UKUH-ICE USE: --G---- ---- -_,// _______________'___------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. ----------------- -------------------- ---------- (Complete in Duplicate) f 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 Ordinance No. 549. JOB ADDRESS AND LOCATION-------3_f-O-p-------------- -,------- ] ' �., - ----------------- --S-�K N------------------------------------- --- Owner's Name------�►- ------------t'�r.l C.o-l_N---------- ------- --- ------ Phone-Ji_Q6'_&.4_-7 I-------- Address-----_------------------- QS64_- 7I-------- Address-----_-----------------•- Contractor's Name...... l?-`CfJl �_.. _ --•------�5 ---------&e ----------- ------------------- Phone._Ai66.-_3.1__V_L• Installation will serve: Residence 5� Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ----I--- Number of bedrooms _.Z Number of baths ___!___ Lot size _---. -- -_____X... ' --------•----------- Water Supply: Public system (9 Community system ❑ Private ❑ Depth to Water Table _-A- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑.,.Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 0 Hardpan ❑ Previous Application Made: (If yes,date.......i. t._-------) No New Construction: Yes ❑ No g FHA/VA: Yes ❑ 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-----------------Distance from foundation ___________________Material_________-_..._____.._______.- . ❑ No. of compartments--- --------------------Size--------------------------------Liquid depth-------------------- Capacity---------------------- Disposal ------- Disoal Field: , Distance from nearest well..14-c_N_C-Distance from foundation--------Ia__'__.__Distance to nearest lot line------Number of lines______________ -------------------Length of each line--------- _"-----___ --..Width of french---------- -` " ----------- .-- �VP Type of filter material_tS}_-Qo- --Depth of filter material---- -__--Tota! length___________________________- fl-' . Seepage Pit: E Distance to neapestwwell_/*N;� ---__Distance from foundation----- 'UDistance to nearest lot line_____._.._____ �YV �qp Number of pits:!-.---I-------------Lining material__S•._, _ Size: Diameter--- --- • -----Dept h----------2-sS ------------ Cesspool: Distance from nearest well---------_-------Distance from foundation -________.___._...Lining material____. El Size: Diameter-�--- --------------- ----------------Depth--------------- ------------------------------------Liquid Capacity....-----------------------gals. In Privy: Distance from nearest well----- _------------------------------------------Distance from nearest building-.g ❑ Distance to nearest lot line ----------------------- ------------------ -------------------- -- ---------------- Q Remodeling and/or repairing (describe):_..___. AP---__.�o �:X��.[_) !r�! q------ -------------------------------------------------------- --- ------------ ----------------------------------------------------------•------------------------------------------------------------------- --- -----------------------------------------I--------- 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 (Owner and/or Contractor) By:---------- --- ------;-- --------------- --- =------------------------------------------ -{Title] - ------------- (Plot plan, showing size of lot, location of system to relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY,,, �a3 q �, APPLICi�TION ACCEPTED BY- --- ---- -•- -4•G�L- -�--------- -------------- ----=---------------- ------ DATE.-�--'�--=-��- �---�------="- ---------------- REVIEWED BY ---------- DATE--------------------------------- BUILDING PERMIT ISSUED ] r---------------- - :--- DA•TE Alterations and/or recommendations..___ "..�. ------. pf _ --------------------------------------------- ------------------------- ___ -------------------------------------------_--------------------_-------_-----------------___________________ __r ___________________._____...-._______________-._____-___..____-.______.__._ ________________________________________ _________________________________.__._._ _ _ -i s` __ _______________________________ _ ' _ ___._t.._____.. 1 1 __.-- - ' ..__ ----- - ------7 ------ ---� - ----- ------- --- -- - Rate-----�r-----�� FINAU INSPECTION BY: -- �---------•-�-�-�-- �----�------�- 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.RCG.