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FOR OFFICE USE: -------------------- -------------- -- -- -----------------------�L APPLICATION FOIA- SANITATION PERMIT Permit No. ------------- ---------- ------------ (Complete in Duplicate) ------ - --- ---- .I-- 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.-/I!5;7j— ------ Sc----- --------------------------•---------------------------------------•--- ------------------------ Owner's Name---- CB--A----1. .ez' = = _ Phone ------------------------------- Address Address._.__.--- .. ----------------------------------------------- Contractor's Name------------ - s .. r-------------------------- --------------------- h Installation will serve: Residence Apartment House .❑. Commercial ❑ TrailerCourt ❑ Motel ❑ Other ❑ Number of living units: /__ Number of bedrooms 0.. Number of baths Lot size Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table 4649ff.. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ C1ay Loam ❑ Clay ❑ Adobe &1H"ardpan ❑ Previous Application Made. (If yes,date--------------------1 No [4-.--5ew Construction: Yes ❑ No FHA/VA: Yes ❑ No- TYPE o-TYPE OF INSTALLATION AND SPECIFICATIONS: i 4 (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank- i Distance from nearest well-----------------Distance from foundation.....-._...__-_. Material_-_..-......-._____........-._____....--_.-_.I' Acyl�hx* No. of compartments--------------------------Size--------------------------------Liquid depth-------------------------.Capacity-------------------- Disposal,Fiel,d: Distance from nearest well______________ __Distance from foundation...._.......-.._----Distance to nearest lot line...-__-...._.--. . Number of lines----'------------------------------Length of each line------------------------------Width of trench------------------------------------ Type ------------------------------Type of filter materiaf-------------------------Depth of filter material ----------------------Total length------------------------------------------ Seepage Pit: Distance to nearest well....___—..-..DistanC r fou a n. '.. Is Vice to nearest lot li�e.,� ��ff: Number of pits- ..------ --Lining materia:. .-_Size: Diameter -----------Deptl t"v- - - -. a � p Brest well-----------------Distan from fo on Cesspool, material---------------- ---------___.--- ess oo: Distance from ne ❑ Size: Diameter--_!J------------------------------ Depth----------------------------------- ------- --------Liquid Capacity-----------------------------gals. Privy- '1 ., F ❑ crest welL-----------------------------------------------Distance from nearest building--------------------------------------- riv Distance to nearest lot line--------- - -- --- ------------------------------------------------------------------------------------------------------------- -- Remodeling and/or repairing (describe� 14e? �� ---- - --- ------------------------------------------- ---------------------------------------------------------------------------- - --------------------------------------------------------------- ------•------------------•---------------------------------------------------------------------------------------------------- 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. i I (Signed} - -' - �- � - -------------------- ---- ------------------------------------------_---- ------- -----�or Contractor) By: -••--------------------- --------------------------(Title) (Plot plan, showing size of lot, location system , relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY.... -._ / �//��- DATE - - �----------------------- REVIEWEDBY-------------------------------------------- --------------- --------------------------------------------------------------- DATE BUILDING PERMIT ISSUED------------------------------------------------------ -------—------------------------------------- DATE•------------- = ------ Alterations and/or recommendations--------------------------------- ----------------------------------••----------------------------------------------•--- t -------------------------------•------------------ •------ -------------- -- ------ ------------------------------ 11 1i 1 ---------- ----- I. ----------------------- -------- -------- -------------------------------------- ----------------------------------------------------------------------- -- -- ----------- --------------------------------------------- ---------------------------------------------------------------------- ------••--------- I - ----------------------------- - ---------------- ------ - -- •------------ ------------- ------------------------------------------------------------------------------ -------------------------------- -- { FINAL INSPECTION BY:-- --- -------- - ------- ------------ Date- �' 4 SAN JOAQUIN LOCAL HEALTH DISTRICT 1401 E.Hazelton Av&. :. a 300 West Oak Street 124 Sycamore Street 205 West 9th Street eStockton,California? rt Lodi,California _ Manteca,California„ Tracy,California I, �{. r F.P.co. s�"'k+.► � �i i,