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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. ! �-. ••••_- --------------------------------------- ----------------- (Complete in Duplicate) __ ..... 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---------- -.�.---. .............. ------- . _ -- ---------------------------- Owner's Name----------------1 t"_T J `7` � `.+ ,1 l- - i�-------" '-------------------------------- Phone_.6G.'574?1_61Z- ------ 7� r, Address------------------------- ---- ......... ............... �1 ��' ------------F-------- --------------------------------------••------------........... Contractor's Name /j 7' f `�/ -----�----.S-'< iY.�------;T ' Phone..�� f��?� Installation will serve: Residence ❑Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __J___ Number of bedrooms _l'__ Number of baths ___f___ Lot size -------�Qr _. - - r Water Supply: Public system r[0/Community system El Private 171 Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam E[/'Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date_f-.___..__.._...) No ❑ New Construction: Yes ❑ No ❑ 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 Field: Distance from nearest well------- Distance from foundation__,-?A2.......Distance to nearest lot line-A.9-------- Number of lines-----s._�__...._. _ _ _ .-___Length of each line___..��%__/_____________Width of trench_ "_--------------___ Type of filter materiai_ C�flL'.__Depth of filter material_../_Z--11_____--Total length------ `''_______-________- _ Seepage Pit: Distance to nearest well-------"-----------Distance fr m foundation____ r�r?a.-__.Distance to nearest lot line.....�j___--_ � Number of pits------ ±_.__.__ ---Lining material---- !4`� � :Size: Dia meter.'___ .��.._._-Depth____v _`��__`_______________ Cesspool: Distance from nearest well-----------------Distance from foundation--------------_F---Lining material __...._---_------_--__-..----___.-.. ❑ Size: Diameter------- -------r._ ----- Depth_-- --------z--; fiLiquicl Capacity----------------------------gals. -- -- - -- -- ----- Privy: Distance from nearest well----------------------------------__- ----Distance from nearest building______-___._________-_______.________. ❑ Distance to nearest lot line.----. ---------------------- ----------------------------------------------------------------------------- ---------------- , ;-� Remodeling and/or repairing {describe):;___-:- ----�-- L-- :._-----.-------------------- ------- ------------------------------------------- �'` --- -------- I-- ----- - --- ----- ------ -------- --------------------------------------------------- i ------------------------------------------ -------------------------- ---------------------•---------------------------------------------------------------- -------------------------------------------------------------- I hereby certify that I have preparedthis application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and"re ulations of the San Joaquin Local, alth District. ' /=` / r /7� (�---__-_____. �/YS."f____ - ./✓�-_.. Owner and/or Contractor (Signed)------------------ a .( ) ._... (Plot plan, showing''siz of lot, location �f system in relation to wells, buildings, etc., can be placed on reverse side}. i --FOR'DEPARTMENT USE'ONLY` APPLICATION ACCEPTED BY_ ---y . - ----- ---- --------------------------------- ------------- ---- DATE----- _A�4� REVIEWEDBY--------------------------------------------- ---- ---------------------------- -------------------------- ------------ I•--- DATE--------------------"--- ---------- BUILDINGPERMIT ISSUED-------------------------------------------------------------- ( ----------!-- DATE------------------------------------------------------------ Aiterations and/or recommendations•_�RF ate-b:S''' /-------- ------ �• - -•� � ------------------------------------------------------------------------------------- f ---------- -------------------------------------------------------- - ------------------------------------------------------------------------------------------------------------------------------------------------ % FINAL INSPECTION BY:... - ---------------- ' (p ---------------------------- ------------- 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.