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FOR OFFICE USE- .�.��Y-�.G1_------�-"�'� `' Permit No. ._.-_------- APPhICATION FOR SANITATION PERMIT ------------ (Complete in Duplicate) Dafe�lssued ------------ _... _ .:.� - } _`_ --- 'This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Healfh District for a permit to construct and install the work herein described. This applicatiori is made in compliance with County,Ordinance No. 549. r i. ------------------------- JOB ADDRESS AND LOCATION_ . I a -r6?.,4r,)------------------------------------------------- ---- Owner's Name." Phone --- -------- ----------- ----•----•----------------....----------•----- Address •------ .yryt , ^'� N `I �, Contractor's Name.:_--Q �.............----•- - - - - ---------------------------- - - - - - - -------- -------------------- -------------------------------------------- Install will serve: .Residence ❑ Apartment House Commercial ❑ Trai4er Court ❑ Motel ❑ Other 2�A Number of living units: JZ Number of bedrooms/Z-- Number of baths _l:Z,_ Lot size ---------------- ---- Wafer Supply: Public system Community system ❑ Private ❑ Depth to Water Table --aft. ;t; Character of soil to a depth of 3 feed: ISand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe —Hardpan ❑ Previous Application Made: (If yes,date-----------_-..-.--) 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 T k: Distance from nearest well.__- --.---Distance from foundation_.--.------.-:----.Material------_---------------------------------------- - � No. of compartments--------: ----------- Size-------------------------------Liquid depth---------- ------Capacity------ ---------------- I t j f rest lot line_...__......_ Disposal Fi�: Distance from nearest well-----------------Distance from foundation--------- ------Distance to nea ..-- Number of lines-±----Q._ ---------Length of each line-Z.0--- ----------- Width of trench... --- --- -------------- i Type of filter material-. QG 1<-------Depth of filter material ------ -------Total lengfh__-_iha-_--_--------�-------�- i k I t I ` Seepage Pit: Distance to nearest well_.__ -----_.-------Distance foundation-----�--------Distance to nearest lot line---------- ---- Number of pits.-Ir-1------------ --Lining material-- �-----G-'..Size. Diameter._11.r-----11-- ---.Depth--------------�f--------------- 00 Cesspool: 5 Distance ,from nearest well----------------- from foundation....................Lining material.....-.__...----- als, N { ❑ Size: Diameter.�� i .........Depth----------------------------------------------------Liquid Capacity----------------------------g r 1 ` Priv Distance from nearest well-------.-.-_------------------ ----------- ---Distance from nearest building----------------------------------------- Privy _-_.__. _._---- .-__--..-. Y=_ , ❑ Distance to nearest lot line.......--------------------------- -- . r � t Remodeling and/or repairing (describe):-------- ------------ --------------------- ------------- --- -----------------= = �_ ----------- - - I ------ 4 ._j-- ----------- -- t Q- ---------- --- - ----------------------------------------------------------------------------------------------------- I hereby certify that I have prepared fhis•.application and that +he work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of +he San Joaquin Local Health District. I ----------- ------ ------------------------ ------------------(Owner and/or Contractor) t 4 -- - -------------- -------------------(Title)------ ---------------------------- --- --- ------------- '(Plot plan, showing size of�Iot. location system in relation to wells, buildings, etc., can be placed on reverse side). #. ) FOR DEPARTMENT USE ONLY APPLlCATlON ACCEPTED BY � = DATE-------- - ----------- ----------------------- REVIEWED BY- --------------------- ---------------- - - ----- -------------------------- --------------------------- DATE------------------------------- ---------------------------- iDATE----------------------------------------------------------- BUILDING PERMIT ISSUED--s---------i- ---- --- ------------------ - ------------------------------------- Alterations and/or recommendations:----- - � ----- 1 -.� :Y------------- ------------ ----------•---•------•-----------------=---------------------------------- --------------- ----•------------------- 1 ---------- - ------------ ------- -----------------------i -------------------- --------- ------- ------------ ------------- ---------------I-------------------- ----------- -------------------------------------------- - - �z /6 Date------------------------�--- ------- - -------------------------- --------------- -------- FINAL INSPECTION BY:-------f-_ SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca, California Tracy,California